Sedgwick

Claims Specialist

• 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 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 Examiner – Workers Compensation, TX/OK/LA Licensing

Client Services Representative

• Manage accounts of locally assigned programs including monitoring procedures and processes that impact customer satisfaction; and to ensure consistency in service delivery.
• Perform contract renewal and Client Service Instruction preparation for assigned accounts.
• Coordinate renewal pricing and complete location coding parameters; prepare and distribute stewardship and other reports.
• Educate the client on loss data - drivers of cost impacting assigned programs.
• Coordinate project activity.
• Act as primary client contact with focus on maintaining and improving overall customer satisfaction.
• Identify issues that impact consistency and customer satisfaction; work with program management leadership to effect problem resolution; and assist with identifying office level service trends and establish plans for service improvement.
• Identify and solicit cross selling opportunities.

Vice President

• Provides senior leadership to VP and Director level colleagues responsible for the execution of core and strategic initiatives.
• Provides strategic and tactical direction for all areas within responsible domains.
• Manages highly technical teams working on large complex multi-million-dollar initiatives.
• Partners with cross-functional delivery organizations to define and deliver the best outcomes for the business.
• Collaborates with product, operations, finance, and enterprise IT peers.
• Leads geographically dispersed teams delivering and supporting large-scale initiatives.
• Executes the multi‑year technology roadmap defined by the Managing Director, ensuring delivery quality and alignment with business unit needs.
• Leads the successful development, delivery, and ongoing support for IT initiatives.
• Creates efficiencies and capacity through the implementation of AI, training, elimination of technical debt, and process optimization.
• Drives Quarterly Business Reviews (QBR’s) and solicits partners on areas of improvement.
• Plans and manages budgets for large complex projects and executes them within time and budget.
• Responsible for feasibility studies, time and cost estimates, and the establishment and implementation of new or revised applications, systems, and programs.
• Fosters a culture of innovation and continuous improvement.
• Supports transformation and strategic initiatives.
• Remains focused on enhancing the customer experience.
• Build strong relationships with business leaders to position IT as a trusted advisor and strategic enabler.
• Communicates complex technical concepts in clear, business-relevant terms to executive stakeholders.
• Leads, mentors, and managed a high-performing team of IT professionals responsible for day‑to‑day execution and support.
• Manages vendor relationships and ensure delivery excellence from third-party partners.
• Engages with peers and leaders across a large, demographically dispersed organization.
• Manages the department budget to ensure financial resources are allocated effectively and align with business priorities.
• Promotes and inclusive and accountable culture.

SVP IT – Business Partner

• Analyze complex medical malpractice claims
• Provide resolutions for highly complex claims
• Manage claim costs and customer service levels
• Communicate claim activity and maintain client relationships
• Ensure proper documentation of claim files
• Mentor assigned staff

Senior Claims Specialist, Professional Liability – Medical Malpractice

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

Claims Adjuster – Workers Compensation

• 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 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 – Work Comp Experience Required

• 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
• 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

Director, Client Services – Workforce Absence

• 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.

Claims Examiner, Liability, GL and Bodily Injury, Litigation Preferred

IT Support

• To manage day-to-day activities and project activities of software developers, systems analysts, or support teams.
• To oversee quality assurance reviews.
• To ensure project completion and user satisfaction.
• To provide guidance and training to assigned team.
• To develop and implement standards and relevant processes.
• To provide administrative guidance and controls ensuring quality, thorough analysis, timely delivery and productivity.
• To assist with strategic planning.
• Oversees support of applications through interaction with business users, stakeholders, IT project managers, IT analysts, and IT development staff.
• Provides leadership, direction to IT teams.
• Ensures support processes and procedures are adhered to.
• Ensures departmental objectives are met.
• Works with stakeholders to manage project priority and planning.
• Actively engages stakeholders and other organizational leaders to ensure satisfaction with service delivery.
• Oversees department projects ensuring on-time and on-budget delivery.

IT Manager

• 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 Examiner – Texas Non-Subscriber

• To analyze reported lower-level level general liability claims to determine benefits due
• Ensures ongoing adjudication of claims within company standards and industry best practices
• 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
• Performs other duties as assigned
• Supports the organization's quality program(s)

Claims Associate – Liability

• 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 clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.

Claims Examiner – Liability, License & General Liability/Bodily Injury Experience

Engineer

• Support the Claims department by ensuring vehicles involved in accidents are repaired correctly or valued if beyond repair
• Assess vehicle damage and determine repair methods
• Liaise with repair shops
• Review claims and provide cost estimates
• Keep customers informed, balancing technical assessments with customer interactions
• Collaborate with the engineering team and other departments

Desktop Motor Engineer

Manager

• Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process.
• Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation.
• Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.

Field Case Manager

• 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
• 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
• Approves claim payments
• 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.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).