Claims Associate

Sedgwick•Bartlesville, OK

About The Position

The Claims Associate analyzes reported lower-level workers compensation claims to determine benefits due and ensures ongoing adjudication within company standards and industry best practices. The role adjusts medical-only claims and minor lost-time workers compensation claims under close supervision, and supports other claims representatives, examiners, and leads with larger or more complex claims as needed. The position also processes workers compensation claims, determining compensability and benefits due; monitors reserve accuracy; files necessary documentation with state agencies; communicates claim actions and processing with claimants, clients, and appropriate medical contacts; and maintains accurate claim documentation and coding. It may include processing routine payments and prescriptions and preparing status reports for lifetime medical claims or defined-period medical claims. The colleague maintains professional client relationships, supports the organization's quality programs, and performs other duties as assigned.

Requirements

One year of general office experience or an equivalent combination of education and experience.
High school diploma or GED.
Licenses as required.
Excellent oral and written communication skills.
PC literacy, 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.
Ability to keyboard using a computer.
Hearing, vision, and talking abilities.
Clear and conceptual thinking ability, excellent judgment and discretion, and ability to meet deadlines.

Nice To Haves

Claims industry experience.

Responsibilities

Adjust medical-only and minor lost-time workers compensation claims under close supervision.
Support other claims representatives, examiners, and leads with larger or more complex claims as needed.
Process workers compensation claims and determine compensability and benefits due.
Monitor reserve accuracy and file necessary documentation with state agencies.
Communicate claim actions and processing with claimants, clients, and appropriate medical contacts.
Ensure claim files are properly documented and claims coding is correct.
Process routine payments and prescriptions and prepare status reports for lifetime medical claims and/or defined-period medical claims, as applicable.
Maintain professional client relationships.
Support the organization's quality program(s).
Perform other duties as assigned.