Sedgwick

Claims Specialist

• Analyze reported lower-level level general liability claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Handle lower-level liability and/or physical damage claims under close supervision
• Support other claims representatives, examiners and leads with larger or more complex claims as necessary
• Process general liability claims determining compensability and benefits due
• Monitor reserve accuracy, and file necessary documentation with state agency
• Communicate claim action/processing with claimant, client and appropriate medical contact
• Ensure claim files are properly documented and claims coding is correct
• Maintain professional client relationships

Claims Associate – Liability

• Analyze and process complex bodily injury auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability, and evaluating the scope of damages
• Analyze complex auto bodily injury claims on behalf of clients
• Process complex auto commercial and personal line claims, including bodily injury
• Ensure claim files are properly documented and coded correctly
• Responsible for litigation process on litigated claims
• Coordinate vendor management, including use of independent adjusters
• Report large claims to excess carrier(s)
• Develop and maintain action plans to ensure state required contact deadlines are met
• Identify and pursue subrogation and risk transfer opportunities; secure and dispose of salvage
• Communicate claim action/processing with insured, client, and agent or broker when appropriate
• Perform other duties as assigned
• Support the organization's quality program(s).

Claims Examiner – Auto, Bodily Injury

• To analyze and process complex bodily injury auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
• Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.
• Performs other duties as assigned. Supports the organization's quality program(s).

Claims Examiner, Auto – Bodily Injury

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Liability Claims Adjuster – General Liability, Bodily Injury, Property Damage

Marketing

• Leads the development of marketing strategies to support growth by partnering with business unit Presidents and their teams
• Collaborates with marketing centers of excellence to deploy marketing tactics in support of strategies
• Provides stakeholder updates to business unit leadership; shares results and optimizes plans based on learnings
• Leads integrated marketing campaigns spanning awareness, engagement, activation and sales enablement
• Responsible for team marketing budget and Agile Team resources towards the highest value growth initiatives

Director, Integrated Marketing Strategy

• Processes and review subrogation claims across all lines of business and all jurisdictions with a mid-level caseload and complexity.
• Processes payment checks received in accordance with company check processing guidelines.
• Processes regular recovery files.
• Coordinates with collection agencies and adheres to company standards and industry best practices within the Claims Recovery Team.
• Responsible for assigned inventory of mid-level subrogation files with recovery.
• Maintains a diary, on cadence, aligned to department service expectations and schedules follow up to ensure timely payment.
• Processes recoveries into various claims systems to ensure the recovery dollars are applied to appropriate claims file.
• Analyzes and processes invoices for various internal/external vendors involved in recoveries including attorneys, collections, and independent investigators.
• Works with collections agencies when appropriate to collect from at-fault parties and records details in claims file.
• Notifies appropriate parties of subrogation lien.
• Uses technology and resources as needed to complete investigation.
• Responds to clients' questions timely and professionally.
• Prepares various type status reports for clients.

Recovery Claims Representative, License Required

• Analyze Workers Compensation claims to determine benefits due.
• Manage complex workers’ compensation claims from initial investigation through final resolution.
• Evaluate claim exposure and develop action plans.
• Negotiate settlements and ensure compliance with guidelines.
• Establish and maintain accurate reserves throughout the life of each claim.
• Compute and issue benefit payments, adjustments, and settlements timely.
• Prepare and submit required state filings within deadlines.
• Oversee litigation and partner with vendors.
• Communicate with claimants and clients frequently.

Claims Examiner – Workers Compensation

• To analyze complex errors and omissions, directors and officers claims.
• To provide resolution of highly complex nature and/or severe injury claims.
• To coordinate case management within Company standards, industry best practices and specific client service requirements.
• To manage total claim costs while providing high levels of customer service.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim costs for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Delegates work and mentors assigned staff.
• Performs other duties as assigned.

Senior Claims Specialist – Professional Liability

Compliance

• Direct delivery of workers’ compensation legislative, regulatory and precedential case law information
• Provide technical consultation to customers, prospects, and client services relative to workers' compensation issues and strategies
• Supports and provides assistance for company initiatives and serves as WC technical expert to other departments within the company
• Monitors federal and state workers’ compensation statutes, regulations, and case law to identify changes that impact claims administration
• Assists in supporting sales and account management
• Leads the development and/or revision of WC service expectations and best practices
• Oversees the development and operationalization of specific state strategies to address WC compliance issues and challenges
• Attends and presents at industry conferences
• Directs the research of technical questions or issues involving WC matters
• Provides communication to colleagues and/or clients relative to workers’ compensation jurisdictional changes or carrier requirements
• Develops and maintains content on Workers’ Compensation portal site
• Identifies current and/or emerging workers’ compensation jurisdictional trends and issues, then direct development and implementation of action plans
• Handles carrier and client technical issues as assigned
• Prepares training outlines; develops modules in cooperation with Sedgwick University, schedules and delivers training presentations; and monitors training compliance and results
• Identifies opportunities to reduce costs and improve efficiencies for workers’ compensation vendors managed

AVP National Technical Compliance

Security Engineer

• Engineers, implements and monitors security measures for the protection of computer systems, networks and information.
• Identifies and defines system security requirements.
• Designs computer security architecture and develops detailed cyber security designs.
• Prepares and documents standard operating procedures and protocols.
• Configures and troubleshoots security infrastructure devices.
• Develops technical solutions and new security tools to assist in mitigating security vulnerabilities and automating repeatable tasks.
• Leads IT groups and business units as necessary in troubleshooting compatibility issues between security tools and business or productivity programs.
• Performs analysis of suspected malicious code and other software or programs and provides written or verbal analysis to management.
• Analyzes client and customer needs as required and provides clear and concise reports to leadership.
• Works closely with management on assigned projects from inception through implementation ensuring adequate internal communication and user involvement is maintained.
• Configuration and management of endpoint detection and response (EDR) policies.
• Integration with Microsoft 365 Defender and Microsoft Entra ID for threat analytics and identity protection.
• Monitoring and responding to security alerts, incidents, and automated investigations.
• Implementation of attack surface reduction rules, antivirus policies, and device control settings.
• Deployment and management of Application Allowlisting, Ringfencing™, and Storage Control policies.
• Configuration of Elevation Control and Network Access Control to enforce Zero Trust principles.
• Analysis of policy violations and threat events to continuously improve endpoint security posture.
• Collaboration with IT and security teams to align ThreatLocker policies with organizational risk tolerance and compliance requirements.
• Strong understanding of Zero Trust architecture, endpoint hardening, and real-time threat mitigation strategies.

Senior IT Security Engineering Advisor

Operations

• Provide leadership, direction, and functional expertise on complex projects
• Develops and executes strategic initiatives and procedures in partnership with claims operations leadership teams
• Directs/executes approved strategy decisions and establishes priorities
• Partners with care team and claims operations support teams to enhance quality
• Delivers well-structured and impactful business reports and presentations to leadership

VP Care Team Operations

• Responsible for overall operations management for all assigned locations/offices
• Establishes policy and procedures to assure compliance to best practices
• Establishes business plan with goals and objectives for the partnership and locations/offices
• Monitors management reports relating to the partner/office performance
• Assists with the coordination of sales and client service efforts

Director of Operations

Manager

• Serve as patient advocate to support, guide and coordinate care for injured workers.
• Assist injured workers in achieving recovery through advocacy and communication.
• Identify appropriate providers and facilities while ensuring timely and cost-effective resource use.

RN Field Case Manager

• Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process.
• Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation.
• Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.