Work Comp Claims Negotiator

By joining Sedgwick, you'll be part of something truly meaningful. Itu2019s 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, thereu2019s no limit to what you can achieve. Newsweek Recognizes Sedgwick as Americau2019s Greatest Workplaces National Top Companies Certified as a Great Place to Worku00ae Fortune Best Workplaces in Financial Services & Insurance Work Comp Claims Negotiator 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 RESPONSBILITIES + Performs other duties as assigned. + Supports the organization's quality program(s). 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

Created: 2025-11-13