[Remote] Workers Compensation Consultant - Level 1

Note: The job is a remote job and is open to candidates in USA. Sedgwick is a recognized leader in the financial services and insurance sector, dedicated to supporting people facing unexpected challenges. They are seeking a Workers Compensation Consultant - Level 1 to analyze and manage less complex workers compensation claims, ensuring compliance and effective communication with stakeholders.

Responsibilities

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency
• Communicates claim action/processing with claimant, client and appropriate medical contact
• Ensures claim files are properly documented and claims coding is correct
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
• Maintains professional client relationships
• Performs other duties as assigned
• Supports the organization's quality program(s)

Skills

• High school diploma required
• One (1) year of general office experience or equivalent combination of education and experience required
• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies
• Claims industry experience preferred
• Paralegal expertise for handling claims, appeals, and compliance matters
• Strong knowledge of workers' compensation legislation and health & safety standards
• Proven ability to manage complex claims processes and collaborate with stakeholders
• Experience in HR leave programs, disability case management, and policy interpretation

Company Overview