Claims Associate

Company: Sedgwick Claims Management Services Ltd
Location: Honolulu
Posted on: February 10, 2025

Job Description:

Global Privacy PolicySedgwick's caring counts commitment is to value the right of privacy of the companies and individuals we serve. It is Sedgwick's policy to comply with all applicable privacy and data protection laws and maintain the trust of those we serve.We want to share with you our policy to what personal information we may collect, how we may use this information and other important areas relating to your privacy and data protection. Please find below links to the policies that apply to all internet sites and applications of Sedgwick and its groups of companies.Claims AssociatePRIMARY PURPOSE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• 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.ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Performs other duties as assigned.
• Supports the organization's quality program(s).QUALIFICATIONEducation & LicensingHigh school diploma or GED required. Licenses as required.ExperienceOne (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.Skills & Knowledge
• Excellent oral and written communication skills
• PC literate, 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 CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.Physical: Computer keyboarding, travel as required.Auditory/Visual: Hearing, vision and talking.The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.About UsTaking care of people is at the heart of everything we do. Caring countsSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts.
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Keywords: Sedgwick Claims Management Services Ltd, Honolulu , Claims Associate, Other , Honolulu, Hawaii