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.

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Triage Associate

PRIMARY PURPOSE: To provide initial research/data collection on new workers compensation (WC) claims; to assist in prompt and accurate reporting of required and situational claim data elements to the Bureau of Workers Compensation (BWC) via electronic data transmission; and to receive, review and research new claim EDI transmission from BWC.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Receives notices of new claims via telephone, BWC-EDA-148 transmissions, or first report of injury (FROI) through FROI form, C-9, and other documentation; and receives, reviews and researches FROI reports to obtain required and situational data elements to facilitate initial EDI to BWC.Receives, reviews and researches new EDI transmissions from BWC to identify case acuity level and refers to disability management per CHS policy; initiates first EDI on new claim within four (4) calendar days.Communicates with service provider, injured worker and employer to obtain accurate data elements for evaluation and identification of acuity level.Identifies appropriate staff to facilitate prompt assignment of new claims.Identifies barriers to a return-to-work (RTW) status as they relate to the functional requirements of the injured worker's job duties.Identifies appropriate referrals for Remain-at-Work and Vocational Rehabilitation Services; communicates this to assigned staff.Educates employers to expedite early communications for FROI and RTW Services through CHS medical case management process.Maintains current knowledge of BWC rules/laws, WC process and CHS policies and procedures.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.Supports the organization's quality programs.

QUALIFICATIONS

Education & Licensing

High School diploma or GED required. Licenses as required.

Experience

One (1) year of general office experience or equivalent combination of education and experience required. Insurance industry experience preferred.

Skills & Knowledge

Excellent oral and written communicationPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsGood interpersonal skillsAbility to provide accurate and prompt researchAbility to provide confirmation for identification of the Degree of Disability Management (DoDM)Ability to work in a team environmentAbility to meet or exceed Performance Competencies

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

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.