Sedgwick

Claims Specialist

• Analyzes and processes complex or technically difficult general liability 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
• Assesses liability and resolves claims within evaluation
• 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 claims 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

Claims Examiner – General Liability, Public Entity Experience Required

• Analyze complex or technically difficult medical malpractice claims.
• Provide resolution of highly complex nature and/or severe injury claims.
• Coordinate case management within Company standards.
• Manage total claim costs while providing high levels of customer service.
• Investigate and gather information to determine the exposure on the claim.
• Conduct or assign full investigation and provide report of investigation.
• Negotiate claim settlement up to designated authority level.
• Calculate and assign timely and appropriate reserves to claims.
• Recommends settlement strategies; brings structured settlement proposals as necessary.
• Coordinates legal defense by assigning attorney and coordinating support for investigation.
• Monitors counsel for compliance with client guidelines.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities.

Senior Claims Specialist, Professional Liability, Medical Malpractice, Long Term Care

Compliance

• Proactively assists with fraud and compliance initiatives such as the prevention, detection, investigation and resolution of fraud & compliance issues through research, investigation and analysis.
• Supports the corporate anti-fraud mission including the prevention, detection, investigation and resolution of fraud & compliance issues through research, investigation and analysis.
• Manages the annual fraud reporting process for carrier partners and state regulators.
• Supports Sedgwick SIU through regulatory compliance reporting and requests.
• Conducts and analyzes the mining of “big data” using advanced data analysis techniques to detect aberrancies and outliers to identify the presence fraud symptoms.
• Develops advanced algorithms, queries and reports to detect potential fraud or other compliance trends and patterns.
• Manages the Sanctions Screening process for anti-money laundering (AML), Foreign Corrupt Practices Act (FCPA), Office of Foreign Assets (OFAC) and other state countries.
• Contributes to the root cause analysis on internal and external fraud and compliance events.
• Monitors industry news and fraud and compliance trends to develop actionable intelligence for fraud and compliance risk identification and mitigation.

Fraud & Compliance Investigator

Backend Engineer

• Lead the design and development of scalable backend systems that support enterprise applications and integrations.
• Architect, build, and maintain RESTful and event-driven APIs for internal and external consumers.
• Design abstraction layers that expose functionality from legacy systems in a secure, modern, and reusable manner.
• Develop middleware services to translate, normalize, and orchestrate data between legacy platforms and modern applications.
• Integrate with legacy systems using available interfaces such as SOAP, REST, JDBC/ODBC, message queues, flat files, or proprietary APIs.
• Build API gateways and service layers that handle authentication, rate limiting, logging, and monitoring.
• Design and implement data transformation logic to map legacy schemas to modern domain models.
• Develop asynchronous processing pipelines using queues, event streams, or batch processing frameworks.
• Optimize backend services for performance, scalability, reliability, and fault tolerance.
• Implement caching strategies and database performance tuning techniques.
• Create robust error-handling and retry mechanisms for unstable or high-latency legacy endpoints.
• Ensure secure integration using OAuth2, JWT, mutual TLS, SAML, or other enterprise authentication mechanisms.
• Work closely with enterprise architects and infrastructure teams to modernize legacy integration patterns.
• Participate in system decomposition initiatives, including incremental migration from monoliths to microservices.
• Write comprehensive unit, integration, and contract tests to ensure API reliability.
• Document API specifications using OpenAPI/Swagger or similar standards.
• Implement logging, tracing, and monitoring using observability tools.
• Support CI/CD pipelines for automated builds, deployments, and environment promotion.
• Troubleshoot production issues related to system integration, performance bottlenecks, or data inconsistencies.
• Mentor junior developers on integration patterns, clean architecture, and backend best practices.

Senior Backend Developer

Administrative Assistant

• To provide administrative support including preparing correspondence and reports.
• Filing and other general office support activities.
• Produces correspondence, reports, and other documentation.
• Files documents, maintains and tracks suspense file, photocopies, sends and receives facsimile transmissions.
• Provides back-up telephone support.
• Processes invoices and billings; maintains records.
• Maintains unit attendance records; library and/or manuals.
• Records meeting minutes.
• Makes travel arrangements.
• Maintains adequate supply inventory; orders supplies as needed.

• To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• 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.

Claims Examiner – Workers Compensation

Operations

• Serves as a operational thought partner on the execution of business performance, execution priorities, and organizational effectiveness.
• Supports the President in setting clear priorities, reinforcing accountability, and driving focus across the Casualty leadership team.
• Acts as an extension of the President in advancing key operational initiatives and leadership commitments.
• Leads and oversees high-impact, cross-functional initiatives that support Casualty's strategic priorities, including operational excellence, service delivery, colleague retention, and scalability.
• Ensures initiatives are well-governed, appropriately resourced, and executed with rigor across regions and lines of business.
• Identifies execution risks, interdependencies, and capacity constraints, bringing forward recommendations to senior leadership.
• Owns the Casualty leadership operating cadence, including preparation and follow-through for operating reviews, performance forums, and leadership meetings.
• Partners with Finance, Operations, CR and IT to ensure consistent performance reporting, KPI discipline, and insight-driven decision-making.
• Drives clarity on goals, metrics, and outcomes across the Casualty organization.
• Works closely with Operations, Client Services, Finance, CR, IT, Learning & Development, and other enabling functions to ensure alignment and execution of Casualty priorities.
• Supports large-scale change initiatives by reinforcing adoption, readiness, and sustained behavior change across leadership teams.
• Elevates the quality, clarity, and consistency of communication across the Casualty leadership team.

SVP, Casualty Operations Enablement

Data Engineer

• Design and implement robust ETL/ELT pipelines to ingest data from legacy on-prem sources, AWS (S3/RDS), and Azure (Blob/SQL), centralizing it for consumption in Snowflake and AI services.
• Build and maintain Feature Stores and specialized datasets optimized for machine learning, ensuring Data Scientists have immediate access to clean, versioned, and statistically valid data.
• Develop the data pipelines required for Generative AI, including the automated extraction, chunking, and loading of unstructured data into vector stores across AWS and Azure.
• Act as the technical lead for our Snowflake data warehouse, implementing sophisticated data modeling, Snowpipe automation, and compute optimization to support high-concurrency AI workloads.
• Execute non-invasive data extraction patterns to unlock mission-critical data from decades-old on-premise systems without disrupting core business operations.
• Manage complex, cross-platform data workflows using Airflow, Step Functions, or Azure Data Factory, ensuring the synchronization of data across our multi-cloud AI posture.
• Partner directly with central IT, Database Administrators, and Security teams to solve connectivity hurdles (PrivateLink, IAM, firewalls) and secure 'license to operate' for new data flows.
• Implement automated validation and observability layers to detect data drift and quality issues that could compromise the accuracy of production AI and Data Science models.
• Drive the efficiency of our data stack by optimizing storage and query performance in Snowflake, AWS, and Azure to manage the ROI of the Transformation Office.
• Work as a dedicated engineering partner to MLOps and Data Science teams to rapidly iterate on data requirements for evolving AI use cases.

Senior Data Engineer – Data Science, AI

AI Engineer

• Lead the architecture and delivery of enterprise-grade LLM and agentic AI systems that transform claims, risk, and operational workflows.
• Define technical strategy for retrieval-augmented generation (RAG), multi-agent orchestration, and autonomous workflow automation.
• Design and implement advanced agentic systems capable of planning, reasoning, tool selection, execution, reflection, and recovery.
• Architect stateful, memory-aware AI systems that manage long-running claims processes across multiple touchpoints.
• Build multi-agent collaboration models that coordinate coverage analysis, document validation, fraud signals, compliance checks, and decision support.
• Establish orchestration frameworks that manage task routing, context persistence, structured outputs, and failure handling.
• Design secure tool integration layers connecting agents to claims systems, policy platforms, data warehouses, document repositories, and external data services.
• Implement deterministic guardrails, schema validation, and output verification pipelines to reduce hallucination and execution risk.
• Lead development of document intelligence systems leveraging LLMs for summarization, entity extraction, discrepancy detection, and structured data reconstruction.
• Define prompt engineering standards and reusable reasoning templates for consistent, domain-aware outputs.
• Oversee embedding strategies, vector indexing architecture, retrieval optimization, and knowledge grounding approaches.
• Design evaluation frameworks to measure reasoning depth, workflow completion accuracy, hallucination rates, latency, and cost efficiency.
• Implement observability layers that track agent decisions, tool usage, retrieval effectiveness, and drift across models and prompts.
• Drive optimization strategies for token efficiency, caching, batching, and inference scaling.
• Ensure compliance with Responsible AI principles, enterprise governance standards, audit requirements, and regulatory constraints.
• Partner with enterprise architecture, cybersecurity, and data governance teams to define secure deployment patterns.
• Mentor engineers on LLM orchestration patterns, workflow decomposition, and safe agent design.
• Translate executive-level business objectives into scalable AI platform capabilities.
• Lead proof-of-concepts through full production deployment with measurable ROI outcomes.
• Continuously evaluate emerging foundation models, orchestration frameworks, and agent tooling for enterprise readiness.

Senior Applied & Agentic AI Engineer

Product Designer

• Lead the end-to-end user experience design for AI-powered applications supporting claims, risk, and client servicing workflows.
• Design intuitive interfaces for LLM-driven tools, agentic AI assistants, and workflow automation platforms used by adjusters, examiners, supervisors, and clients.
• Translate complex AI capabilities such as reasoning outputs, confidence scores, document summaries, and workflow recommendations into clear, actionable UI patterns.
• Create user experiences that balance automation with human oversight, ensuring appropriate human-in-the-loop controls.
• Design interaction models for conversational AI, structured AI outputs, and multi-step AI-assisted workflows.
• Develop wireframes, prototypes, and high-fidelity mockups for AI-enabled dashboards and case management tools.
• Conduct user research with claims professionals to understand workflows, pain points, and adoption barriers.
• Map end-to-end claims journeys and identify high-impact opportunities for AI augmentation.
• Design explainability and transparency components that help users understand AI reasoning and outputs.
• Ensure interfaces clearly communicate system limitations, confidence levels, and required human actions.
• Collaborate closely with AI engineers to align UX patterns with system capabilities and constraints.
• Partner with product managers to define feature requirements and prioritize enhancements.
• Develop and maintain a consistent design system tailored to Sedgwick AI platforms.
• Create usability testing plans and gather feedback to iteratively refine AI-driven features.
• Ensure accessibility, inclusivity, and compliance with enterprise design standards.
• Optimize user workflows to reduce clicks, manual rework, and cognitive load.
• Design dashboards that surface AI insights, alerts, and workflow statuses in a clear and actionable format.
• Document UX guidelines for AI-assisted decision support systems.
• Contribute to change management efforts by designing onboarding experiences for AI adoption.

UX Designer

Account Manager

• Provide account support for complex Service Center clients
• Maintain and strengthen client relationships
• Support program procedures and processes that impact customer satisfaction ensuring consistency in process within the account
• Coordinates new client implementation, addition of expanded lines of business, client and organizational level dissemination changes and special service requests
• Responds to and resolves program management and client issues including coordination of process changes with internal and outside provider resources
• Communicates with leadership team and internal/external resources to resolve service issues ensuring client satisfaction and retention
• Proactively identifies issues that impact customer satisfaction; works with department management and key vendors to develop plans addressing these issues
• Participates in client meetings, conference calls and presentations representing the National Service Center
• Performs other duties as assigned

Assistant National Account Manager

Vice President

• Leads transformation initiatives that support business unit growth objectives
• Partners with divisional and functional leaders to identify and focus on high-value initiatives
• Designs and delivers transformation programs by coordinating cross-functional teams
• Accelerates deployment of innovative solutions in collaboration with technology and business leaders
• Applies analytical rigor to diagnose root causes, solve complex business problems, and inform decision-making
• Drives adoption and cultural alignment with proactive change management strategies
• Serves as a trusted advisor by bringing strategic insight to leadership discussions

Vice President, Business Transformation

• To analyze complex or technically difficult general 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.
• Analyzes and processes complex or technically difficult general liability 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.
• Assesses liability and resolves claims within evaluation.
• 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; settles claims within designated authority level.

Claims Examiner – Liability, License Required

Data Scientist

• Lead the design and development of advanced statistical and machine learning models that improve claims outcomes, operational efficiency, and risk management.
• Serve as the technical authority for complex modeling initiatives including fraud detection, claims severity prediction, litigation risk modeling, and recovery optimization.
• Develop predictive and prescriptive models using structured and unstructured claims data, including adjuster notes, medical records, and policy documentation.
• Architect modeling approaches that leverage modern techniques such as gradient boosting, deep learning, NLP, anomaly detection, and probabilistic modeling.
• Partner with AI Engineering teams to productionize models and integrate them into enterprise AI platforms and operational systems.
• Design feature engineering strategies and modeling pipelines using large-scale enterprise datasets.
• Establish best practices for model development, experimentation, validation, and reproducibility.
• Lead advanced analytical techniques such as causal inference, scenario simulation, and risk scoring methodologies.
• Build and maintain model evaluation frameworks that measure accuracy, bias, stability, and business impact.
• Monitor deployed models for drift, degradation, and changing data distributions, and recommend recalibration strategies.
• Provide technical guidance to data scientists and analysts across the organization.
• Mentor junior team members on statistical methods, machine learning techniques, and analytical rigor.
• Translate complex analytical findings into clear, actionable insights for business leaders and operational teams.
• Collaborate with Claims Operations, Finance, Risk, and IT stakeholders to identify high-impact analytical opportunities.
• Evaluate external data sources and third-party analytical solutions that enhance predictive capabilities.
• Ensure analytical methodologies align with enterprise governance standards and regulatory expectations.
• Contribute to Sedgwick’s broader AI and advanced analytics strategy by identifying emerging technologies and modeling approaches.
• Lead research and innovation initiatives that advance Sedgwick’s predictive analytics capabilities.

Principal Data Scientist

Project Manager

• To develop and manage strategic project assignments through completion;
• To lead and direct strategic project teams;
• To manage and communicate results;
• To make recommendations to management;
• To provide training.