Claims Representative (IAP): Workers Compensation Training Program | Concord, CA

Sedgwick•Concord, CA

5d•Onsite

About The Position

This role is for an entry-level trainee position within the Workers Compensation Training Program. It offers an opportunity to develop a professional career in a stable, office-based work environment. The program includes training to investigate and resolve complex situations for employees and customers. There are also career development and promotional growth opportunities. Sedgwick is recognized by Newsweek as one of America's Greatest Workplaces and is a Certified Great Place to Work® and a Fortune Best Workplace in Financial Services & Insurance.

Requirements

High School Diploma or GED.
2 years of customer service experience and/or combination of education and experience.
Strong Communicators
Empathetic
Multi-Taskers
Accountable
Structured Thinkers
Ambitious
Agile Learners
Team Collaborators

Nice To Haves

Bachelor's degree preferred

Responsibilities

Attendance and completion of designated claims professional training program.
Adjusting various levels of workers’ compensation claims under close supervision.
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.