Workers Compensation Claims Representative – Medical Only, VA Jurisdiction

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Manage low-level medical-only Workers Compensation claims for a specific client.

• Assess benefits due and ensure continuous adjudication adhering to company standards and industry best practices.

• Recognize subrogation claims and negotiate settlements under general supervision.

• Evaluate and process claims through action plans to ensure appropriate and timely resolutions.

• Investigate claims and collect information to assess claim exposure.

• Negotiate claim settlements within the specified authority.

• Communicate claim activities and processing updates with claimants and clients.

• Report claims to the excess carrier.

• Professionally and promptly respond to requests for guidance.

• Collaborate within Sedgwick’s global network of experts to provide customer-facing solutions.

⛳️ Requirements

• Minimum of 2 years of claims management experience or an equivalent combination of education and experience is necessary.

• A High School Diploma or GED is required.

• A Bachelor's degree from an accredited institution is preferred.

• Professional certification relevant to the line of business is preferred.

• Familiarity with the VA jurisdiction is essential.

• Capability to process low-level medical-only Workers Compensation claims.

• Proficiency in investigating claims and collecting information to assess claim exposure.

• Ability to negotiate settlements within the designated authority.

• Competence in communicating claim activities and processing with claimants and clients.

• Must be able to report claims to the excess carrier and respond to requests for guidance.

• Must fulfill applicable work authorization and legal requirements.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunity to operate in an agile environment.

• Career development and promotional growth opportunities.

• Medical, dental, and vision benefits available from day one.

• 401K plan with matching contributions.

• Paid Time Off (PTO).

• Disability and life insurance coverage.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.

• Flexibility and autonomy in daily work, location, and career trajectory.

• Opportunities for professional development.