workers compensation claims representative

State of Ohio

<div><div>BWC&rsquo;s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC&rsquo;s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.
What our employees have to say: 
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:<ul><li>
BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.</li><li>
I have worked at several state agencies and BWC is the best place to work.</li><li>
Best place to work in the state and with a sense of family and support.</li><li>
I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.</li><li>
I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.</li></ul>
If you are interested in helping BWC grow, please
What You&rsquo;ll Be Doing:<ul><li>
Manages a caseload of Workers&rsquo; Compensation claims: Communicates, coordinates &amp; collaborates with internal &amp; external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety &amp; Hygiene, injured workers, employers, Third Party Administrators [TPA] &amp; rehabilitation personnel) in order to set return to work expectations.</li><li>
Performs initial/subsequent claims investigation &amp; determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, &amp; work history of claimant).</li><li>
Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders &amp; referrals to the Industrial Commission (IC) of Ohio</li><li>
Responds to customer inquiries</li><li>
Follows Ohio Revised Code and BWC policies and procedures</li><li>
Communicates with legal representatives, employers, claimants, etc.</li></ul>
Why Work for the State of Ohio
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
<ul>
<li>Medical Coverage</li>
<li>Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period</li>
<li>Paid time off, including vacation, personal, sick leave and 11 paid holidays per year</li>
<li>Childbirth, Adoption, and Foster Care leave</li>
<li>Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)</li>
<li>Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) &amp; Optional Deferred Compensation (Ohio Deferred Compensation)</li>
</ul>
<ul><li>Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.</li></ul>
Qualifications<div>
36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
 
 
<ul><li>Or Completion of undergraduate core coursework in business, humanities, social &amp; behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
</li></ul> 
-Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate &amp; in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT &amp; taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers &amp; updating claim information, &amp; managing caseload of self-insured medical &amp; disability claims to ensure compliance with Ohio Workers' Compensation Law).
 
 
<ul><li>Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &amp;/or answering complaints, questions &amp;/or telephone inquiries &amp;/or written correspondence from customers pertaining to claims status or procedures, reviewing &amp; analyzing claims, referring customers to available community services, &amp; conducting telephone interviews with citizens reporting fraud allegations) &amp;/or as BWC Employer Service Representative, 63521, (i.e., providing information &amp; assistance &amp;/or responding to complaints, questions &amp; inquiries from customers regarding workers&rsquo; compensation coverage, established binder/applications maintenance, demographics, supplemental &amp; legal entities, manual classifications, debits/credits &amp; payroll reports &amp;/or various BWC programs &amp; research &amp; explain employer refunds, attorney general balances, payments made to policies &amp;/or divided credits).
</li></ul> 
<ul><li>Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims &amp; paying medical claims for Ohio Bureau Of Workers' Compensation).
</li></ul> 
<ul><li>Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &amp;/or as Workers' Compensation Claims Assistant, 16720 &amp;/or as Workers' Customer Service Representative, 64451 &amp;/or as Workers&rsquo; Compensation Employer Service Representative, 63521.
</li></ul> 
<ul><li>Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.
</li></ul> 
Job Skills: Claims Examination</div>

Major Worker Characteristics:

Knowledge of: workers' compensation laws, policies &amp; procedures*; eligibility criteria &amp; procedures used for processing workers' compensation claims*; English grammar &amp; spelling; oral &amp; written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals &amp; percentages; interviewing techniques; internet search engines &amp; navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*;
Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers&rsquo; Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;
Ability to: define problems, collect data, establish facts, &amp; draw valid conclusions; read &amp; understand medical reference manuals &amp; reports, gather, collate, &amp; classify information about data, people, or things; respond to sensitive inquiries from &amp; contacts with injured workers, employers, providers or their representatives, &amp; the public; answer routine &amp; technical inquiries from injured workers, employers, medical providers &amp; public*; make proper referrals (within agency &amp; external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.
Supplemental Information
EEO &amp; ADA Statement: 
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.
The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox eeodept@bwc.ohio.gov.
BWC OCSEA Selection Rights: 
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Salary Information: 
Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
Educational Transcripts: 
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check: 
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.
ADA Statement
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Drug-Free Workplace
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.</div></div>

WC Claims Specialist (PN: 20069075 & 20069204)

Elevate Patient Financial Solutions

<div><div><div>Elevate Patient Financial Solutions is seeking detail-oriented and proactive professionals to join our team as a Workers Compensation Claims Representative &quot;TEMP&quot;. This remote, full-time opportunity offers a consistent schedule of Monday - Friday 8:00am -4:30pm CST. If you're passionate about making a meaningful impact and growing your career in a purpose-driven environment, this is your opportunity to shine!</div>
<div></div><div>In 2024, our Workers Compensation department resolved over 175,000 claims on behalf of our hospital clients and their patients.</div>
<div></div><div>In this role, you&rsquo;ll play a key part in helping hospitals and medical providers get paid for care as a result of work-related injuries. You&rsquo;ll gather important workers&rsquo; compensation details and insurance information by working closely with hospitals, employers, patients, and other sources. You&rsquo;ll also handle submitting claims and documentation to insurance carriers, reviewing payments and denials, and writing appeals when needed. Throughout the process, you&rsquo;ll stay in touch with insurance companies, employers, attorneys, and patients to make sure everything moves smoothly and providers receive the payments they&rsquo;re owed.</div> 
 
Job Summary 
 
The purpose of this position is to assist hospitals and medical providers in resolving accounts that are a result of work-related injuries. Specifically, this position is focused on the effort to obtain Workers&rsquo; Compensation injury details and insurance information from hospital, employers, patients and from other sources; submission of insurance bills and documentation to Workers&rsquo; Compensation insurance carriers; review of payments and denials for potential appeal; writing and submitting appeals; and communication with insurance carriers, employers, attorneys and patients during the claims adjudication process to ensure that the hospital and/or medical providers receive appropriate payment on submitted bills and denied claims. 
 
Essential Duties and Responsibilities</div>
<ul><li>Maintain a queue of Workers&rsquo; Compensation accounts as assigned by management.</li>
<li>Maintain quality and productivity levels set by management once full job proficiency has been achieved.</li>
<li>Contact patient&rsquo;s employer, Workers&rsquo; Compensation carrier, and injured worker via telephone and mail to obtain injury information and insurance information.</li>
<li>Support patients by answering any questions about the Workers&rsquo; Compensation process.</li>
<li>Coordinate with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.</li>
<li>Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.</li>
<li>Perform manual data entry of patient accounts and/or claim forms.</li>
<li>Submit hospital and physician bills to insurance companies for payment.</li>
<li>Maintain contact with insurance adjusters/carriers, employers, and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.</li>
<li>Obtain claim status and gather supporting documentation to submit appeals.</li>
<li>Make written or verbal appeals to payers on denied claims.</li>
<li>Provide strong customer service to clients and provide responses to client inquiries within 24 hours.</li>
<li>Provide detailed updates to Elevate PFS&rsquo;s account management system and hospital/provider practice management system as account work is completed.</li>
<li>Assist in training both new and existing employees, which may include contributing specific training material.</li>
<li>Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively.</li>
<li>Identify and discuss root cause issues with management.</li>
<li>Maintain and updates proper account documents in multiple systems.</li>
<li>Assist management with ad hoc inventory initiatives and other projects, as needed.</li>
<li>Review and manage patient accounts to ensure that proper documentation, payments, and necessary letters of authorization are entered correctly.</li>
<li>Maintain and adhere to compliance policies and procedures</li>
<li>Other duties as assigned.</li>
</ul>
<div> 
Qualifications and Requirements 
 
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.</div>
<ul><li>High School Diploma or GED</li>
<li>Some college coursework preferred</li>
<li>Positive and encouraging attitude</li>
<li>Strong customer service background</li>
<li>Professional, accurate, clear, and concise communication, both verbal and written, including the ability to write routine business correspondence</li>
<li>Detailed and thorough</li>
<li>Adaptable</li>
<li>Organized and excel in time management. Ability to manage and move quickly and accurately through a large workload</li>
<li>Proven ability to be assertive in order to proactively resolve issues.</li>
<li>Demonstrated ability to organize and set priorities according to changing situations and demands</li>
<li>Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.</li>
<li>Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications</li>
<li>1-5 years of related experience in the field or in a related area such as:</li>
<li>Medical billing and coding</li>
<li>Medical appeals</li>
<li>Claims Adjudication</li>
<li>Insurance</li>
<li>Workers&rsquo; Compensation</li>
<li>Legal work</li>
</ul>
<div> 
Benefits 
 
ElevatePFS believes in making a positive impact not only within our industry but also with our employees &ndash;the organization&rsquo;s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.</div>
<div></div><ul><li>Medical, Dental &amp; Vision Insurance</li>
<li>401K (100% match for the first 3% &amp; 50% match for the next 2%)</li>
<li>15 days of PTO</li>
<li>7 paid Holidays</li>
<li>2 Floating holidays</li>
<li>1 Elevate Day (floating holiday)</li>
<li>Pet Insurance</li>
<li>Employee referral bonus program</li>
<li>Teamwork: We believe in teamwork and having fun together</li>
<li>Career Growth: Gain great experience to promote to higher roles</li>
</ul>
<div> 
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage. 
 
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change. 
 
Elevate, PFS is an Equal Opportunity Employer</div></div>

Workers Comp Claims Representative "TEMP"

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Representative (IAP): Workers Compensation Training Program | West Hills, CA
<div><div><div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
</div></div><div><div><div><div><div><div><div><div><div><ul><li>A stable and consistent work environment in an office setting.
</li><li>A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world&rsquo;s most reputable brands.
</li><li>Career development and promotional growth opportunities through increasing responsibilities.
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision &amp; 401k. 
 
</li></ul>PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you&rsquo;ll have the opportunity to grow and advance within the industry.
Next Class Date: June 1, 2026
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
<ul><li>Strong Communicators
</li><li>Empathetic
</li><li>Multi-Taskers
</li><li>Accountable
</li><li>Structured Thinkers
</li><li>Ambitious
</li><li>Agile Learners
</li><li>Team Collaborators 
 
</li></ul>ESSENTIAL RESPONSIBLITIES INCLUDE
<ul><li>Attendance and completion of designated claims professional training program.
</li><li>Adjusting various levels of workers&rsquo; compensation claims under close supervision, which includes:
</li><li>Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
</li><li>Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
</li><li>Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
</li><li>Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
</li><li>Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
</li><li>Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
</li><li>Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
</li></ul>QUALIFICATIONS
Education Requirement &ndash; High School Diploma or GED.
EXPERIENCE
No experience required.
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 $27.69/hr. 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.
</div></div></div></div></div></div></div></div></div></div>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&rsquo; 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.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Representative (IAP): Workers Compensation Training Program | West Hills, CA

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Representative (IAP): Workers Compensation Training Program | Long Beach, CA
<div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
<ul><li>A stable and consistent work environment in an office setting.
</li><li>A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world&rsquo;s most reputable brands.
</li><li>Career development and promotional growth opportunities through increasing responsibilities.
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision &amp; 401k. 
 
</li></ul>PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you&rsquo;ll have the opportunity to grow and advance within the industry.
Next Class Date: June 1, 2026
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
<ul><li>Strong Communicators
</li><li>Empathetic
</li><li>Multi-Taskers
</li><li>Accountable
</li><li>Structured Thinkers
</li><li>Ambitious
</li><li>Agile Learners
</li><li>Team Collaborators 
 
</li></ul>ESSENTIAL RESPONSIBLITIES INCLUDE
<ul><li>Attendance and completion of designated claims professional training program.
</li><li>Adjusting various levels of workers&rsquo; compensation claims under close supervision, which includes:
</li><li>Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
</li><li>Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
</li><li>Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
</li><li>Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
</li><li>Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
</li><li>Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
</li><li>Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
</li></ul>QUALIFICATIONS
Education Requirement &ndash; High School Diploma or GED.
EXPERIENCE
No experience required.
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 $27.69/hr. 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.
</div>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&rsquo; 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.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Representative (IAP): Workers Compensation Training Program | Long Beach, CA

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Job Posting Title Claims Representative (IAP): Workers Compensation Training Program | Ontario
<div><div><div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
</div></div><div><div><div><div><div><div><div><div><div><ul><li>A stable and consistent work environment in an office setting.
</li><li>A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world&rsquo;s most reputable brands.
</li><li>Career development and promotional growth opportunities through increasing responsibilities.
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision &amp; 401k. 
 
</li></ul>PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you&rsquo;ll have the opportunity to grow and advance within the industry.
Next Class Date: June 1, 2026
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
<ul><li>Strong Communicators
</li><li>Empathetic
</li><li>Multi-Taskers
</li><li>Accountable
</li><li>Structured Thinkers
</li><li>Ambitious
</li><li>Agile Learners
</li><li>Team Collaborators 
 
</li></ul>ESSENTIAL RESPONSIBLITIES INCLUDE
<ul><li>Attendance and completion of designated claims professional training program.
</li><li>Adjusting various levels of workers&rsquo; compensation claims under close supervision, which includes:
</li><li>Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
</li><li>Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
</li><li>Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
</li><li>Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
</li><li>Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
</li><li>Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
</li><li>Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
</li></ul>QUALIFICATIONS
Education Requirement &ndash; High School Diploma or GED.
EXPERIENCE
No experience required.
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 $27.69/hr. 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.
</div></div></div></div></div></div></div></div></div></div>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&rsquo; 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.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Representative (IAP): Workers Compensation Training Program | Ontario, CA

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Representative (IAP): Workers Compensation Training Program | Rancho Cordova, CA
<div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
<ul><li>A stable and consistent work environment in an office setting.
</li><li>A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world&rsquo;s most reputable brands.
</li><li>Career development and promotional growth opportunities through increasing responsibilities.
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision &amp; 401k. 
 
</li></ul>PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you&rsquo;ll have the opportunity to grow and advance within the industry.
Next Class Date: June 1, 2026
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
<ul><li>Strong Communicators
</li><li>Empathetic
</li><li>Multi-Taskers
</li><li>Accountable
</li><li>Structured Thinkers
</li><li>Ambitious
</li><li>Agile Learners
</li><li>Team Collaborators 
 
</li></ul>ESSENTIAL RESPONSIBLITIES INCLUDE
<ul><li>Attendance and completion of designated claims professional training program.
</li><li>Adjusting various levels of workers&rsquo; compensation claims under close supervision, which includes:
</li><li>Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
</li><li>Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
</li><li>Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
</li><li>Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
</li><li>Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
</li><li>Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
</li><li>Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
</li></ul>QUALIFICATIONS
Education Requirement &ndash; High School Diploma or GED.
EXPERIENCE
No experience required.
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 $27.69/hr. 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.
</div>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&rsquo; 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.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Representative (IAP): Workers Compensation Training Program | Rancho Cordova, CA

Aultman Health System

<div><div><div>PURPOSE OF POSITION:
The Account Representative has four major areas of responsibility, which are listed below:
<div><ul><li>Attend all of AultComp&rsquo;s hearings before the Industrial Commission of Ohio, unless the presence of an attorney is required.
</li></ul><ul><li>Manage the claims of designated self-insured employers.
</li></ul><ul><li>Manage the claims of all state fund employers.
</li></ul><ul><li>Market the services of the TPA, including the group rating program.
</li></ul></div>In performing the above tasks, the Account Representative will assist the Claims Coordinator, Clinical Editor, and the Customer with litigation issues, medical bill issues, and claims management issues. The Account Representative will request medical documentation from providers in order to prepare for hearings, schedule independent medical exams, and negotiate lump sum settlements. The Account Representative will also file motions, appeals, objections, lump sum settlement applications, and any other relevant correspondence with the Bureau of Workers&rsquo; Compensation and the Industrial Commission of Ohio, act as a liaison between the Customer and the Manager, and generate administrative billing. A more detailed description of the position is listed below. 

RESPONSIBILITIES &amp; EXPECTATIONS:
<ul><li>Prepare docket based upon district, time, issue, and level of hearing.</li>
<li>Attend all hearings in the Akron and Cambridge district offices unless an attorney is requested or there is a time conflict.</li>
<li>Review and prepare all hearing files and distribute to subcontractors when appropriate.</li>
<li>Advise Claims Coordinators regarding the information needed for hearings.</li>
<li>Advise Clinical Editor regarding contested claims so bills are not paid in error.</li>
<li>File appeals, objections, reconsiderations, motions, lump sum settlement applications, and any other correspondence with the Bureau of Workers&rsquo; Compensation and Industrial Commission of Ohio.</li>
<li>Initiate settlement correspondence for self-insured and state fund clients.</li>
<li>Request medical documentation for hearings from attending physicians and any other provider who administered treatment.</li>
<li>Act as account representative for self-insured and state fund employers, advising clients regarding allowance or denial of claims, return to restricted duty, lump sum settlements, extent of disability, allowance or denial of additional conditions, treatment issues, independent medical exams, permanent partial disability objections, and hearing strategies.</li>
<li>Market TPA services to self-insured, state funded, and group rated clients.</li>
<li>Coordinate mailing of group rating material.</li>
<li>Maintain group rating database.</li>
<li>Prepare and mail group rating proposals</li>
<li>Coordinate all correspondence with group administrators.</li>
<li>Generate administrative billing, process payments, and maintain billing database.</li>
<li>Authorize and submit subcontractor&rsquo;s fees to finance for payment.</li></ul> 

<ul><li>Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
</li><li>Seeks supervisory guidance/approval as appropriate.</li>
<li>Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.</li>
<li>Promotes and demonstrates professional standards to enhance the development of the department.
</li><li>Practices ethical conduct.</li>
<li>Meets acceptable attendance and punctuality expectations (excluding FMLA)</li>
<li>Reviews the files of self-insured clients to ensure that they are meeting BWC audit requirements.
</li><li>Reviews policies maintained on the Policy and Procedures website that pertain to the position.</li>
</ul>
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not considered a detailed description of all the work requirements that may be inherent to this position. 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
QUALIFICATIONS:
<ul><li>Education: Bachelor&rsquo;s Degree required.</li>
<li>Experience: Knowledge of medical terminology,
</li><li>Mastery of Microsoft Word, Excel and Outlook.</li>
<li>Proficient with basic math skills.
</li><li>Prior employment with a workers&rsquo; compensation third party administrator or the Ohio Bureau of Workers&rsquo; Compensation required.</li></ul> 

WORKING CONDITIONS:
<ul><li>Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
</li><li>Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.</li>
<li>Sitting/standing/moving about intermittently during working hours.</li>
<li>Subject to frequent interruptions and changes in priority of duties throughout the day.
</li></ul></div></div> 
Location: Aultman Health Foundation &middot; AC SELF INS - AULTCOMP TPA 
Schedule: Full Time, Day Shift, 8am-5pm</div>

WORKERS COMPENSATION ACCOUNT REPRESENTATIVE

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