Work Comp Claims Services Associate | Hybrid | Sacramento, CA

Sedgwick • Sacramento, CA

12d • $25 - $30 • Hybrid

About The Position

The Claims Services Associate works closely with Workers’ Compensation Program Managers to receive, review, and document California workers’ compensation information as directed. The role communicates as needed with medical facilities, third-party administrators, clients, and staff. The Associate reviews documents and third-party administrator claims systems and may recommend actions to staff to help move workers’ compensation claims toward resolution. The position is hybrid, with two days in Sedgwick’s Sacramento, California office and three days working from home. Career development and promotional growth opportunities are available through increasing responsibilities.

Requirements

• Two years of claims experience or an equivalent combination of education and experience.
• High school diploma or GED.
• Knowledge of state workers’ compensation statutes.
• Proficient math skills.
• Skill with Excel spreadsheets.
• Excellent oral and written communication, including presentation skills.
• PC literacy, including Microsoft Office products.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Responsibilities

• Conduct initial research and data collection on claims files.
• Perform file audits according to jurisdictional standards as directed by the state, carrier, or client.
• Review prior audit results, settled files, and files with no activity, and identify exceptions.
• Coordinate file retrieval and gather data for submission to management.
• Communicate with claim examiners to correct identified deficiencies, providing corrected payment amounts and instructions regarding necessary state form filings.
• Monitor correction of audit exceptions, ensure completion, and assist with filing state forms and submitting payments as necessary.
• Research exceptions on the state’s quarterly compliance report and provide management with detailed responses identifying trends in audit exceptions.
• Review and update notes and diaries in the claims management system as instructed.
• Coordinate jurisdictional training on state-specific tools.
• Support the organization’s quality program(s).
• Perform other duties as assigned.

Benefits

• Career development and promotional growth opportunities through increasing responsibilities.
• Medical, dental, and vision coverage.
• 401(k) and matching.
• Paid time off.
• Disability and life insurance.
• Employee assistance.
• Flexible spending or health savings account.
• Additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED