Claims Associate l Workers' Compensation l Portland, OR Hybrid
Sedgwick is a global industry leader known for its excellence and customer service. The Claims Associate role involves analyzing workers compensation claims to determine benefits due and ensuring claims are adjudicated according to company standards and industry best practices.
Responsibilities
- Adjusts medical-only claims workers compensation claims under close supervision
- Calculate benefits in accordance with state law and Sedgwick guidelines
- Provide administrative support as needed
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency
- 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
Skills
- High school diploma or GED required
- Licenses as required
- One (1) year of general office experience or equivalent combination of education and experience required
- Claims industry experience preferred
Benefits
- Medical
- Dental
- Vision
- 401k and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
Company Overview