Sedgwick

Pricing Analyst

• Process and identify program trends impacting pricing
• Provide support to operational directors, program and office managers in development of program pricing and design
• Provide support for program implementations and department initiatives
• Review contracts and provide billing instructions to billing group
• Design and price new clients and prospective new business opportunities as assigned
• Assist in the design and pricing of client renewals and support operations in renewal development
• Work closely with other departments as appropriate and communicate often with program managers, operations manager, managing departments and legal departments
• Generate ad hoc reporting and analysis as requested by management
• Compile and analyze financial data and make recommendations for improved data capturing and analytics
• Assist in evaluation, development and enhancement of various pricing models
• Provide superior customer service and support to business/management strategies

Claims Specialist

• Independently handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
• Ensure compliance with New York workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
• Negotiate settlements of claims within designated authority to reach claim resolution.
• Provide clear and effective communication with the claimant and client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
• Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.

Workers Compensation Claims Examiner

Manager

• Manage and serve as a resource for Catastrophe (CAT)/Storm events to the Vericlaim Repair Solutions staff
• Coach and mentor CAT contractors on processes and systems
• Monitor CAT contractors Service Level Agreement (SLA) performance objectives
• Prioritize CAT contractor needs for Vericlaim Repair Solutions dedicated staff
• Provide feedback to Operations Team on process challenges facing contractors
• Interface with service providers who comprise the Vericlaim Repair Solutions network's core business
• Perform pricing research/development
• Develop and deliver CAT launch training/coaching (live and onsite if possible)
• Provide onboarding assistance to the Business Development department for new carrier's seeking Cat solution
• Cross-train inter-departmental employees and cross-company employees as needed
• Perform quality assurance inspections as needed
• Serve as subject matter expert and/or project leader on the following industry systems: Xactimate, SettleAssist, EyeSight, MICA, Chronicle, etc.

CAT Team Manager

Content Marketing Manager

• Complete the physical onsite inventory process including: driving to and from the loss location, physical inventory of contents, and uploading data from field work to server.
• Assists in completing the physical onsite inventory of total loss contents items under the direction of Outside Contents Evaluator Associate.
• Tracks time and logs file notes for all of that day’s field activity.
• 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 Contents Evaluator Assistant

• Analyze complex or technically difficult general liability claims to determine benefits due.
• Work with high exposure claims involving litigation and rehabilitation.
• Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
• 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.

Claims Examiner, Liability – TX License Required

• To analyze mid- and higher-level workers compensation claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Identify subrogation of claims and negotiate settlements.
• Develop and manage workers compensation claims' action plans to resolution.
• Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract.
• Communicate claim action with claimant and client.
• Ensure claim files are properly documented and claims coding is correct.

Claims Adjuster – Workers' Comp, NC/SC/VA Exp Needed

• 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 Contents Evaluator Associate

• Complete the physical onsite inventory process including: driving to and from the loss location, physical inventory of contents, and uploading data from field work to server
• Assists in completing the physical onsite inventory of total loss contents items under the direction of Outside Contents Evaluator Associate
• Tracks time and logs file notes for all of that day’s field activity
• 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

Outside Contents Evaluator

• 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.
• Performs other duties as assigned. Supports the organization's quality program(s).

Claims Adjuster – Liability, GL & PD, Licensing: TX/FL or reciprocal required

Accountant

• Lead end-to-end litigation support engagements, including scope, methodology, assessment, and reporting;
• Quantify loss of earnings in insurance, personal injury, motor accident, and dependency matters, including analysis of past and projected earnings capacity, mitigation assumptions, discounting, and critique of opposing expert reports;
• Lead business valuation engagements for disputes, shareholder matters, commercial negotiations, financial reporting, and solvency/insolvency contexts;
• Prepare independent expert reports and affidavits, compliant with relevant expert codes of conduct and provide oral testimony as and when required;
• Contribute to thought leadership, CPD training and seminars, and relationship development with law firms and corporates.
• Building trust and long-term partnerships with clients through responsive, high-quality service.
• Assist with scoping, proposals, fee models, and risk management.
• Uphold independence, ethics, and confidentiality at all times.
• Manage and mentor junior team members.

Senior Manager/Director – Forensic Accountant – Litigation

Customer Support

• Assist in evaluating the medical necessity, appropriateness and efficiency of the health care services and procedures.
• Answer phones for the utilization review department.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Utilization Review Customer Service Representative

Data Analyst

• To develop complex reports and analyze company data including Corporate or client specific data
• Serve as a technical resource for company staff on data analysis and benchmarking issues
• Meet with clients on such issues as necessary
• Provide training and data analysis education for program staff
• Provide technical oversight and guidance to client dedicated analysts located in multiple field offices

Data Consultant – Advanced Data Analyst

• Provide exceptional customer support on Sedgwick’s primary temporary housing line.
• Serve as a working team lead responsible for daily operational oversight, task delegation, and frontline leadership.
• Support policyholders, adjusters, hotels, and partners with housing-related inquiries.
• Assist with inbound calls, hotel bookings and extensions, billing-related questions, and administrative functions.
• Act as the primary decision-maker during assigned shifts.
• Support escalation management and monitor real-time volume.
• Actively perform all customer service duties alongside the team.
• Accurately and efficiently enter new housing claims into internal systems.
• Monitor inbound email queues for claim questions, approvals, and new housing requests.
• Extend hotel stays for clients currently in-house and book hotels when necessary.
• Audit hotel folios and related claims for billing accuracy, compliance, and documentation.
• Manage IVR call flow and routing based on real-time call volume.
• Motivate team members to meet productivity and quality metrics.

Customer Service Team Lead

• 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.

Claims Adjuster – Workers Compensation, Med Only, Indemnity Experience Required

• To process low level workers compensation claims to determine benefits due.
• To ensure ongoing adjudication of claims within company standards and industry best practices.
• To identify subrogation of claims and negotiate settlements with general supervision.
• Processes low level 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 coordinates low level workers compensation 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.
• Communicates claim action with claimant and client.