Claims Representative (IAP) - Workers Compensation Training Program | Roseville, CA or San Diego, CA

Sedgwick•San Diego, CA

2d•Onsite

About The Position

This role is for a new industry professional, starting with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you’ll have the opportunity to grow and advance within the industry. This is an entry-level trainee position for enthusiastic and service-oriented individuals. Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

Requirements

High School Diploma or GED.
Strong Communicators
Empathetic
Multi-Taskers
Accountable
Structured Thinkers
Ambitious
Agile Learners
Team Collaborators

Responsibilities

Attendance and completion of designated claims professional training program.
Adjusting various levels of workers’ compensation claims under close supervision, which includes:
Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements.
Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
Documenting claims files and properly coding claim activity.
Preparing detailed reports documenting findings and recommendations.
Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.