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Sedgwick Claims Management Services

Claims management and risk solutions provider

Claims Representative - Claims Training Program

Claims AdjudicationPosted on Nov 12
Full-time

About the Job

Requirements

  • A high school diploma or GED is required.
  • A bachelor's degree is preferred, along with 2 years of customer service experience and/or a combination of education and experience.
  • Candidates should be strong communicators, empathetic, able to multitask, accountable, structured thinkers, ambitious, agile learners, and team collaborators.
  • Candidates must be able to think clearly and conceptually; exercise judgment, troubleshooting, problem-solving, analysis, and discretion; handle work-related stress and multiple priorities simultaneously; and meet deadlines.
  • Candidates must be able to perform computer keyboarding and meet the auditory, visual, and speaking requirements of the role.

Responsibilities

  • Attend and complete the designated claims professional training program.
  • Adjust various levels of claims under close supervision.
  • Process and respond to incoming mail, emails, and other claim-related documents according to the status of the claim.
  • Communicate with insureds or employers, medical providers, attorneys, and carrier representatives, primarily by telephone, video conference, and email.
  • Investigate new and existing claims by gathering relevant information, including medical records, employer reports, and witness statements; investigate employer/employee relationships, policy verification, coverage, and potential subrogation issues or fraud indicators.
  • Determine coverage, compensability, and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
  • Document claims files and correctly code claim activity; prepare detailed reports documenting findings and recommendations.
  • Administer indemnity and medical claim benefits by maintaining calendared claim-related action items and ensuring state compliance.
  • Participate in virtual and/or in-person meetings, claim reviews, and business functions as needed for educational training, claim discussions, and other meetings.

About the Company

Sedgwick Claims Management Services

Claims management and risk solutions provider

Sedgwick manages claims and risk for insurers, corporations, and public entities. Its services cover the full claims lifecycle, including clinical case management, networks, and cost-containment programs, plus specialized work like home inspections and property appraisals. The company operates by charging fees for these managed services that coordinate medical care, assess losses, and support timely resolution. Sedgwick differentiates itself through its integrated, end-to-end approach to claims management and its strong emphasis on caring for people, DEI, and client outcomes. Its goal is to help clients resolve claims efficiently, restore property and brands, and reduce costs through targeted resources deployed at the right time to improve outcomes.

Company size
10,001+
Company stage
Growth Equity (Non-Venture Capital)
Total funding
$1.5B
Headquarters
Memphis, TN
Founded
1969

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