Sedgwick

Client Services Representative

• To determine account management strategies related to client service plans;
• To be responsible for retention of existing clients, customer satisfaction, revenue growth, client surveys, and new business;
• To provide program management for jumbo clients requiring dedicated staff, multiple offices and complex service models;
• To oversee the work of other local Client Services staff.
• Provides stewardship reporting to clients; identifying and educating clients on issues and trends impacting programs.
• Conducts pre-renewal visits reviewing client loss experience and general company performance.
• Reviews and identifies areas of potential dissatisfaction prior to renewal meetings.
• Performs client renewal, contract revision, and Client Service Instruction preparation for complex programs.
• Negotiates changes or improvements to service plan.
• Facilitates the reduction of process barriers, technology constraints, or resource constraints by directing and influencing the activities of other internal departments such as information technology, operations and business development.
• Coordinates client invoicing, audits and accounts receivable follow up for assigned clients.
• Resolves all major customer service issues.
• Identifies and solicits cross-selling opportunities.
• Participates in local insurance community through advanced education and affiliation memberships.
• Supervises and directs personnel assigned to programs requiring multiple Account Representatives.
• Ensures compliance with all applicable Quality initiatives.

Assistant Vice President – Client Services

Auditor

• To become a member of the Expert Bill Review team and work with insurance defense attorneys
• Leverage legal expertise to apply customer tailored billing guidelines
• Align each review with the customer’s goals and objectives
• Apply and evaluate uniquely tailored legal spend management protocols
• Consult with customers to design and/or enhance legal spend management guidelines and strategies
• Communicate with law firms to discuss billing compliance inquiries
• Manage legal invoice volume and workflow in accordance with customized customer standards
• Use proprietary Legal Spend Management platforms to implement and manage workflows and data collection
• Build strong customer relationships by providing mission critical value to partners’ success

Lawyer Auditor – Avocat vérificateur, Conseillère en matière de litiges

Claims Specialist

• To analyze complex or technically difficult workers' compensation claims to determine benefits due.
• To work with high exposure claims involving litigation and rehabilitation.
• To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
• To identify subrogation of claims and negotiate settlements.
• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
• Manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and 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.

Workers Compensation Claims Examiner

Consultant

• To address and handle high end cases with serious injuries, complex coverage scenarios and legal inquiries or disputes; to develop a strategy to bring a case to satisfactory resolution.
• Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.
• Handles high end cases with serious injuries and/or complex coverage scenarios.
• Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.
• Identifies cases for settlements/redemptions.
• Gathers/documents additional information and coordinates with client designees.
• Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.
• Responds to plaintiff's counsel, union, employee, or client requests.
• Identifies issues and formulates defense strategy.
• Establishes/adjusts accrued liability and approves administrative expenses.
• Identifies subrogation opportunities and manages process.
• Attends and participates in mediations, trials, arbitrations or hearings as needed.
• Works with partners to affect early return-to-work.

Litigation Consultant

• Attendance and completion of designated classroom claims professional training program.
• Performs on-the-job training activities including: Adjusting lost-time workers compensation claims under close supervision.
• May be assigned medical only claims.
• Adjusting low and mid-level liability and/or physical damage claims under close supervision.
• Processing disability claims of minimal disability duration under close supervision.
• Documenting claims files and properly coding claim activity.
• Communicating claim action/processing with claimant and client.
• Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
• Participates in rotational assignments to provide temporary support for office needs.

Claims Representative – Workers Compensation Training Program

• To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due.
• Attendance and completion of designated classroom claims professional training program.
• Performs on-the-job training activities including: Adjusting lost-time workers compensation claims under close supervision.
• May be assigned medical only claims.
• Adjusting low and mid-level liability and/or physical damage claims under close supervision.
• Processing disability claims of minimal disability duration under close supervision.
• Documenting claims files and properly coding claim activity.
• Communicating claim action/processing with claimant and client.
• Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
• Participates in rotational assignments to provide temporary support for office needs.

• Analyze reported lower-level workers compensation claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
• Support other claims representatives, examiners, and leads with larger or more complex claims as necessary
• Process workers compensation 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
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
• Maintain professional client relationships

Assistant Vice President – Client Services

Lawyer Auditor – Avocat vérificateur, Conseillère en matière de litiges

Workers Compensation Claims Examiner

Litigation Consultant

Claims Representative – Workers Compensation Training Program

Claims Representative – Workers Compensation Training Program

Claims Associate – Workers Compensation, Multi State Jurisdiction