Specialty Operations Coordinator

📋 Description

• • Join Sedgwick, a global leader in claims management, and become part of a mission-driven organization dedicated to supporting individuals through life's unexpected challenges. With over 33,000 colleagues worldwide, you'll contribute to a meaningful purpose while growing your career in a supportive and caring culture that prioritizes work-life balance. Sedgwick has been recognized for its exceptional workplace, including accolades from Newsweek as one of America’s Greatest Workplaces, certification as a Great Place to Work®, and recognition on Fortune's Best Workplaces in Financial Services & Insurance.
• • As a Specialty Operations Coordinator, you will play a crucial role in the adjudication of workers' compensation claims. Your primary responsibility will be to analyze low- and mid-level workers' compensation claims to accurately determine benefits due to claimants. You will ensure that all claims are managed in strict adherence to company standards and the highest industry best practices, contributing to Sedgwick's reputation for excellence and compassionate service.
• • We are seeking enthusiastic and driven individuals who thrive in a collaborative team environment and are committed to delivering outstanding work. If you are detail-oriented, possess strong analytical skills, and are eager to make a tangible impact, this role offers a rewarding opportunity to develop your expertise in claims management.
• • *Key Responsibilities and Duties:**
• • **Claims Adjudication:** You will be responsible for adjusting medical-only claims and low- to mid-level lost-time workers' compensation claims. This involves a thorough review of claim details, medical documentation, and applicable state regulations to ensure accurate benefit determination and timely processing.
• • **Support and Collaboration:** Provide essential support to other claims staff, assisting with larger or more complex claims as needed. This collaborative approach ensures that all claims receive the appropriate level of attention and expertise, fostering a cohesive team dynamic.
• • **Benefit Determination:** Meticulously review workers' compensation claims to assess compensability, calculate and determine benefits due to the claimant, and ensure all necessary documentation is accurately filed with the appropriate state agency.
• • **Stakeholder Communication:** Effectively communicate claim status, actions, and processing updates to all relevant parties. This includes claimants, clients, state agencies, managed care organizations, and medical providers, ensuring transparency and maintaining positive relationships.
• • **File Management and Compliance:** Maintain meticulously organized claim files, ensuring all documentation is complete, accurate, and up-to-date. You will be responsible for ensuring correct claims coding and adherence to all regulatory requirements.
• • **Client Relationship Management:** Cultivate and maintain professional, positive, and productive relationships with clients, serving as a reliable point of contact for their claims-related inquiries and needs.
• • **Coordination and Problem Solving:** Coordinate with actuarial and settlement departments on issues that may impact employer rates or claim settlements, ensuring a holistic approach to claim resolution.
• • **Quality Assurance:** Actively support and contribute to the organization's quality programs, demonstrating a commitment to continuous improvement and adherence to high standards of service.
• • **Performance Excellence:** Strive to meet or exceed established performance competencies, demonstrating a dedication to efficiency, accuracy, and claimant satisfaction.
• • **Continuous Learning:** Embrace opportunities for professional development and learning within the claims management field, staying abreast of industry trends and best practices.
• • **Adaptability:** Perform other duties as assigned, demonstrating flexibility and a willingness to contribute to the team's success in various capacities.