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Claims Services Associate

Company: Sedgwick
Location: Syracuse
Posted on: September 13, 2019

Job Description:

Claims Services Assciate

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts--. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
PRIMARY PURPOSE: To review claim files specific to state regulatory requirements; to assist in prompt and accurate reporting of required and jurisdictional claim data elements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES




  • Provides initial research/data collection on claims file.
  • Performs file audits according to jurisdictional standards as directed by state, carrier, or client.
  • Reviews prior audit results, settled files, or files with no activity and identifies exceptions.

  • Coordinates file retrieval, and gathers data for submittal to management.
  • Communicates with claim examiners to correct identified deficiencies by providing corrected payment amount and instructions regarding necessary state form filing.
  • Monitors correction of audit exceptions ensuring completion and assist with filing of state forms and submitting payments as necessary.

  • Researches exceptions on the state's quarterly compliance report and provides detailed response to management identifying trends in audit exceptions.

  • Reviews and updates notes/diaries in claims management system as instructed.


  • Coordinates jurisdictional training on state specific tools.




    ADDITIONAL FUNCTIONS and RESPONSIBILITIES



    • Performs other duties as assigned.
    • Supports the organization's quality program(s).


      QUALIFICATIONS

      Education & Licensing

      High school diploma or GED required.

      Experience

      Two (2) years of claims experience or equivalent combination of education and experience required.

      Skills & Knowledge


      • Knowledge of state workers' compensation statute
      • Proficient math skills
      • Skilled with Excel spreadsheets
      • Excellent oral and written communication, including presentation skills
      • PC literate, including Microsoft Office products
      • Ability to work in a team environment



        • Ability to meet or exceed Performance Competencies

          WORK ENVIRONMENT

          When applicable and appropriate, consideration will be given to reasonable accommodations.

          Mental: Clear and conceptual thinking ability; excellent judgment 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

Keywords: Sedgwick, Syracuse , Claims Services Associate, Other , Syracuse, New York

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