Claims Examiner 5 years Workers Compensation Experience

versatility, and integrity. We also recognize the importance of a true work-life balance and offer flexible work arrangements including full-time and part-time. JOB DESCRIPTION: Insurance Specialist JOB SUMMARY: The primary function of the Insurance Specialist is to contact carrier groups to obtain eligibility information ensuring that the most updated verification is entered into the practice management software.

Develops and maintains effective relationships with the patients ensuring all patient demographic and insurance information is obtained. REQUIRED EDUCATION/EXPERIENCE: High school diploma or GED equivalent; customer service; must be computer literate; have multi-tasking skills,

excellent organizational skills, verbal and written communication skills; team player. POSITION RELATIONSHIPS: · Reports directly to the Billing Manager ESSENTIAL FUNCTIONS · Responsible for effective and efficient verification of all patients?

benefits prior to their appointment. · Responsible for answering incoming calls from other providers, recipients, and carrier groups in relation to insurance coverage. · Research eligibility information online with various insurance carriers. · Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected. · Ensures all patient questions are

answered and issues are resolved timely by utilizing the appropriate resources.

· Responsible for obtaining all referrals and authorizations for procedures and services, as required. · Other duties as assigned by the Billing Manager. PROFESSIONAL: · Treat all patients and staff with compassion and empathy. · Recognize and respect cultural diversity. · Adapt communication to an individual? s ability to understand. · Use medical terminology appropriately. · Respond to communications received within a reasonable time frame. · Assist nursing staff with admission, pre-op and post-op care, discharge, and follow-up care of the patient. · Project a professional manner and image.

· Adhere to ethical principles. · Demonstrate initiative and responsibility. · Work as a team member. · Manage time efficiently, do not participate in gossip or other time-wasting activities. · Prioritize and perform multiple tasks. · Adapt to change, including new hours of operation and methodology. · Attend all staff meetings and mandatory in-service education. · Maintain proper observation and adherence to company policies and procedures, including the Employee Handbook. KNOWLEDGE, SKILLS, AND EXPERIENCE: · Good organizational skills and the ability to multi-task· Ability to operate basic office equipment, answer multi-line telephones, and have a strong computer background.

· Establish and maintain effective working relationships with patients, insurance companies, and staff. · Good written and oral communications. · Knowledge and skills in working with computerized billing systems including practice management software and EMR. · Must adhere to all HIPAA guidelines and regulations. · Knowledge of medical insurance and authorization processes. · Some medical terminology and experience working in a healthcare or insurance environment. LEGAL: · Maintain patient and company confidentiality.

· Practice within the scope of education, training, and personal capabilities. · Document company documents (hard copy and electronic) accurately. · Use appropriate guidelines for releasing information. · Maintain awareness of federal and state health care legislation and regulations; OSHA, CLIA, and HIPAA. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, talk, use repetitive motion, type, and hear. The employee is frequently required to stand, walk, use hands and fingers to handle and feel, and reach with hands and arms. The employee is occasionally required to bend, kneel, crouch, climb stairs, and reach overhead. The employee must occasionally lift and/or move up to 25 pounds. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The omission of specific statements or descriptions does not preclude management from assigning duties not listed herein if such duties are a logical assignment to the position. Job Types: Full-time, Part-time Pay: From $14.00 per hour Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance Schedule: 8 hour shift Monday to Friday Ability to commute/relocate: Lake Mary, FL 32746: Reliably commute or planning to relocate before starting work (Preferred) Experience: Medical billing: 1 year (Preferred) Work Location: One location

support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve.

If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Representative - IAP WC (Entry Level) Atl,

GA/ Lake Mary, FL/Memphis, TN/Charlotte, NC PRIMARY PURPOSE : To be oriented and trained as new industry professional with the ability to analyze workers compensation, general liability or disability claims and determine benefits due.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Attendance and completion of designated classroom claims professional training program. Performs on-the-job training activities including: Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. Adjusting low and mid-level liability and/or physical damage claims under close supervision. Processing disability claims of minimal disability duration under close supervision.

Documenting claims files and properly coding claim activity. Communicating claim action/processing with claimant and client.

Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. Participates in rotational assignments to provide temporary support for office needs. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred or equivalent experience as outlined below. Experience No experience required with college degree. State license, self-insured certificate, WCCA/WCCP designation, or completion of the Sedgwick Claims Progression Program required without a degree.

Prior claims experience preferred. Skills and Knowledge Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical skills 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 NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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. Requisition #: R44411tcv57hlu2

support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve.

If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Examiner PRIMARY PURPOSE : To analyze complex

or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within

designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).

Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When 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 NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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. Requisition #: R43982tcv57hlu2