Claims Services Associate (Hybrid in Sacramento, CA)

Claims Services Associate (Hybrid in Sacramento, CA)

Are you looking for an impactful job that offers an opportunity to develop a professional career?

This role is open to a hybrid setting 2 days in the Sacramento, CA Sedgwick office and 3 days' work at home

Career development and promotional growth opportunities through increasing responsibilities

A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs

Primary Purpose of the Role

To provide excellent customer service and internal support to an assigned team. 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 assists 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

Qualification

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

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

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $28.37 to $32.43 USD hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

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.