Sedgwick

Content Marketing Manager

• Acts as the point of contact for the insured’s, vendors and public adjustor when onsite
• Provides support to the outside contents evaluator assistants
• Prepares field reports of the inventory capture
• Uploads all digital media and completes quality check for daily field activity to maintain accuracy
• Completes onsite inventory of total loss contents items and uploads data from field work to server
• Oversees all necessary maintenance of crew vehicles, including: gas, oil changes, tire rotations, and any other necessary repairs
• Maintains daily care and maintenance of all equipment
• Conforms with and abides by all regulations, policies, work procedures, and instructions

Outside Content Evaluator Associate

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;
• and to ensure ongoing adjudication of claims within company standards and industry best practices or client specific requirements.
• Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim;
• manages claims through well-developed action plans to an appropriate and timely resolution.
• Works to move claim towards appropriate claim closure which may include referral for settlement evaluation.
• Monitors reserve adequacy throughout the life of the claim if applicable.
• Monitors and reviews benefits due and payment calculations ensuring accuracy.
• Prepares necessary state filings within statutory limits.
• Follows best practice standards in contested claims including outside legal representation.
• 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.
• Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
• Ensures claims files are properly documented and claims coding is correct.
• Maintains professional client relationships.
• Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.
• Assesses policy level status of clients; works in coordination with clients' service expectations and assigned service personnel.

Claims Examiner – Workers Comp

• To analyze mid to high level Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations.
• 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 Adjuster, NJ & VA Jurisdictions, Dedicated Client, Capped Caseload

• To analyze Lost-Time Workers Compensation claims on behalf of our valued clients to determine benefits due.
• 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.
• 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 – NY Jurisdiction Experience Required

Data Scientist

• To partner with stakeholders to identify, scope, and execute advanced analytics and data science projects
• To design data modeling processes, create algorithms, and predictive models
• To share insights that inform and enable business decisions
• Builds, prototypes, and deploys machine learning models in production environments
• Collaborates with product, technology, and other stakeholders to identify and scope data science projects
• Communicates modeling challenges, findings, and outcomes to technical and non-technical stakeholders
• Designs and implements end-to-end ETL (extract, transform, load) data pipelines integrating data from multiple data sources
• Explores new internal and external data sources and assesses their commercial benefit
• Mentors team members and serves as a subject matter expert in cross-functional discussions

Senior AI Data Scientist

• To analyze mid- and higher-level workers compensation claims to determine benefits due;
• to ensure ongoing adjudication of claims within company standards and industry best practices;
• and to identify subrogation of claims and negotiate settlements.
• Manage workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develop and manage workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Claims Adjuster – Workers Comp

• To analyze mid- and higher-level general auto claims to determine scope of damages.
• To ensure ongoing adjudication of claims within company standards and industry best practices.
• To identify subrogation of claims and negotiate settlements.
• Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure.
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• Maintains professional client relationships.
• Performs other duties as assigned.

Claims Adjuster, Auto – Property Damage

Data Analyst

• Manage a staff of data analysts
• Develop complex reports and analyze company data
• Serve as a technical resource for company staff
• Meet with clients on data analysis and benchmarking issues
• Provide training and data analysis education for program staff
• Provide technical oversight and guidance to client dedicated analysts

Manager, Data Analyst

• To analyze complex or technically difficult 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 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.

Claims Examiner – Liability, GL, BI, Litigation Experience Required

• Attendance and completion of designated claims professional training program.
• Adjusting various levels of workers’ compensation claims under close supervision.
• Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives.
• Thoroughly investigating new and existing claims by gathering relevant information.
• Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines.
• Documenting claims files and properly coding claim activity.
• Preparing detailed reports documenting findings and recommendations.
• Administering claim benefits through maintenance of calendared claim-related action items.

Claims Representative – Workers Compensation Training Program

• To analyze and process low to mid-level auto and transportation claims.
• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.
• Maintains professional client relations.
• Performs coverage, liability, and damage analysis on all claims assignments.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Claims Representative, Auto

Manager

• To oversee technical and operational functions including compliance with company standards and industry best practices.
• To ensure consistent delivery of quality services.
• To oversee staffing and training needs.
• To oversee budget preparation and profit and loss management.
• Has direct and/or indirect responsibility for 25 or less colleagues.
• Oversees internal quality review process and reports monthly.
• Assures compliance with client internal controls, audit requirements and service agreement requirements.
• Establishes business plan with goals and objectives for assigned clients.
• Ensures claims management policies and procedures are followed to assure meeting service standards, state statutes/regulation, disability plan document, industry best practices and client service requirements.
• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Assists with interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.
• Establishes and maintains client contacts.
• Performs other duties as assigned.

Assistant Manager, Claims

Account Manager

• Manage claim caseload of basic to highly complex claims within granted authority level
• Establish and maintain effective relationships with internal and external customers and coworkers
• Communicate effectively and timely
• Mentor/coaches account representatives and account specialists
• Investigate, evaluate and resolve claims
• Identify potential problems/trends in claim files and take corrective action or make corrective recommendations
• Interpret medical reports and state law or jurisdictional law in claim handling
• Proactively manage litigation in conjunction with client requirements
• Work constructively with client and legal representatives to resolve claims
• Ensure compliance and best possible outcomes by minimizing financial liability
• Compile requirements to prevent penalties and fines

• To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Claims Adjuster – Workers Compensation, Dedicated Account

• To analyze and process low to mid-level auto and transportation claims
• Processes auto property damage and lower level injury claims
• Assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution
• Identifies and pursues subrogation opportunities; secures and disposes of salvage
• Communicates claim action/processing with insured, client, and agent or broker when appropriate
• Maintains professional client relations
• Performs coverage, liability, and damage analysis on all claims assignments
• Performs other duties as assigned
• Supports the organization's quality program(s)
• Travels as required