Claims Associate

Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of more than 14,000 colleagues in some 275 offices located in the U.S., Canada, the U.K and Ireland.

**ESSENTIAL FUNCTIONS and 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 general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary, and settling claims up to the designated authority level. - Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy and files necessary documentation with state agency. - Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments. - 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. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** - Performs other duties as assigned. - Supports the organization's quality program(s).

**QUALIFICATION** **Education & Licensing** - High school diploma or GED required. **Experience** - One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred. Licenses as required. **Skills & Knowledge** - Knowledge of Social Security and Medicare application procedure as applicable to line of business - 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