Sedgwick

Claims Specialist

• Analyze reported lower-level workers compensation claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Adjusts 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; monitors reserve accuracy, and files 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.

Claims Associate – Workers Compensation, Med Only

• 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

• Analyzes and processes complex claims, works with high exposure claims involving litigation, and ensures ongoing claims within service expectations, industry best practices and specific client service requirements.
• Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims across all jurisdictions.
• Manages high-exposure, complex, multi-jurisdictional claims with a focus on identifying and pursuing third-party subrogation opportunities.

Claims Examiner – Recovery

• To analyze reported lower-level level general liability claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Handles lower-level liability and/or physical damage claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes general liability claims determining compensability and benefits due.
• Monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures 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.
• Maintains professional client relationships.

Liability Claims Associate

Operations

• Provides leadership and support in meeting day-to-day Service Center objectives including service excellence; and to support continued Service Center growth and development.
• Manages day-to-day operations ensuring daily client service objectives are met; ensures workload objectives are met timely and accurately.
• Provides professional and organizational development direction to Service Center supervisory staff and in their colleague team development role.
• Produces scheduled reports; maintains reporting databases as instructed.
• Contributes to development schedules for Service Center functional areas effectively balancing client needs with colleague availability and diversity.
• Provides effective and constant communication to Service Center Director and key stakeholders; provides effective communication of Service Center processes and procedures change/updates to internal and external colleague staff.
• Identifies and assists in implementation of various training programs; coordinates training of Service Center colleagues on departmental applications and procedures.
• Represents the company with industry groups.

Manager, Care Team Operations

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim;
• 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;
• manages the litigation process; ensures timely and cost effective claims resolution;
• communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

Claims Examiner – Workers Compensation, Licensing Required

• To process low level property damage and bodily injury claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Identify subrogation of claims and negotiate settlements with general supervision.
• Processes low level property and bodily injury claims by gathering information to determine liability exposure.
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Develops and coordinates low level general liability claims' action plans to resolution.
• Returns to work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.

Claims Representative – Liability, Property Damage, Bodily Injury

• To analyze complex or technically difficult commercial auto liability 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.

Liability Claims Examiner – Auto, Commercial Trucking

Vice President

• Leads transformation initiatives that support business unit growth objectives and deliver measurable impact through structured execution and strategic alignment.
• Partners with divisional and functional leaders to identify and focus on high-value, enterprise-critical initiatives that advance organizational priorities.
• Designs and delivers transformation programs by coordinating cross-functional teams, ensuring seamless execution and alignment with strategic goals.
• Partners with Technology, Data, and Architecture leaders to design fit-for-purpose future states that balance business needs, speed to value, and long-term scalability.
• Drives adoption and cultural alignment by executing proactive change management strategies and engaging stakeholders at all levels.

VP Business Transformation

• Investigates, negotiates, and resolves personal injury protection (PIP) and medical payments (Med Pay) claims in accordance with policy provisions, best practices, and jurisdictional requirements.
• Responsible for the input of claim data and guiding insureds and claimants through the claim process and options.
• Manages claims and adjusts moderately complex to complex, PIP/Med Pay, claims across multiple jurisdictions.
• Investigates loss details, evaluates, negotiates, and resolves claims within appropriate authority guidelines; maintains a high level of productivity, confidentiality, and customer service.
• Reviews assigned files and claim instructions for proper claim handling, establishes reserves and issues payment based on claim details and claim damages.
• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.
• Prioritizes assigned claims workload to keep policyholders and other involved parties informed and provides timely claims status updates.
• Serves as a subject matter expert on of state laws, regulations, statutes, and procedures to ensure proper handling of assigned claims.
• Delivers best in class claim service through setting appropriate expectation proactive communications with customers, brokers, and other claim professionals throughout the claims process.
• Works independently within significant limits and authority on assignments of higher technical complexity and coordination.
• Identifies possibly suspicious claims.
• Takes recorded statements.
• Identifies, confirms, and makes coverage decisions on complex claims.

Claims Examiner – No Fault, PIP, Lit Required

• Evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits
• Review claims to determine the nature of the medical loss and provide explanation of coverage
• Research policy contract and interpret policy language to make coverage decisions based on 1st party medical coverage
• Assess medical treatment, evaluate medical bills, and initiate or review potential fraud investigations
• Interpret medical records regarding injuries and address ongoing treatment for claimants
• Identify claim exposures and establish reserves accordingly on assigned files
• Ensure claim files are properly documented and correctly coded based on the policy
• Document all claim activity accurately throughout the claim life
• Provide effective communication to clients, claimants, medical providers, and vendors
• Negotiate resolution of claims and make payments within authority

Claims Representative, Auto, PIP

• Processes lower level product liability claims by gathering information to determine liability exposure; assign reserve values to claims, determines risk transfer (tender opportunities); settle claims up to designated authority level; make claim payments as necessary.
• Develops and coordinates lower value product liability claims; prepares action plans pursuant to the claim or client contract.
• Negotiates settlements within designated settlement authority.
• Administers subrogation of claims.
• Communicates claim action with claimant and client.
• Ensures claim files are timely handled; properly documented; and claims coding is correct.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Claims Representative – General & Product Liability, Multi State Jurisdiction

Learning and Development

• Facilitate training
• Assess colleague career development needs
• Develop training programs and materials
• Deliver programs when appropriate to analyze, improve and manage performance
• Deliver new colleague orientation
• Monitor development plans
• Oversee performance analyses
• Develop training material, lesson plans, assessment and evaluation for training modules
• Ensure that the training process is properly coordinated, monitored, documented and evaluated
• Coordinate and facilitate technical systems training

Training Specialist

• 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.

Workers Compensation Claims Examiner, CT, MA, NH, RI, VT Jurisdictions

• Process low level general liability claims to determine benefits due;
• Ensure ongoing adjudication of claims within company standards and industry best practices;
• Identify subrogation of claims and negotiate settlements with general supervision.
• Processes low level general liability claims by gathering information to determine liability exposure;
• Assign reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Develops and coordinates low level general liability claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Performs other duties as assigned.
• Supports the organization's quality program(s).