Work Comp Claims Negotiator

Work Comp Claims Negotiator

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance

Primary Purpose : To negotiate out of network bills that do not fall within the confines of a PPO contract. Manage fair and reasonable reimbursements. Maintain consistency and external relationships and internal results. Manage and monitor any reconsiderations or legal actions.

Are You An Ideal Candidate? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

Essential Functions and Responsibilities :

• Negotiates individual bills post services rendered for fair and reasonable reimbursement
• Analyzes resources, data and established methods to assure accuracy.
• Prepares, negotiates, and administers individual agreements.
• Identifies current issues and probable future issues; guides staff through resolution.
• Documents agreements; updates as changes occur.
• Coordinates customer inquiries.

Additional Functions and Responsibilities :

Qualifications

Education & Licensing : Bachelor's degree with major in Health Services or Hospital Administration from an accredited college or university preferred.

Experience : 2-3 years experience processing work comp claims as an examiner. Familiar with CPT, DRG and resources established for "usual and customary". Experience handling legal inquiries.

Skills & Knowledge :

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

Taking Care Of You By :

Next Steps : If your application is selected to advance to the next round, a recruiter will be in touch.

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 $60,000 - $90,000. 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.

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.