Sedgwick

Learning and Development

• To develop training programs related specifically to the claims management system products;
• To design training plans and materials;
• To organize and conduct complex training programs.
• Trains instructors or delivers instructor-led classroom sessions to users.
• Consults with claims management to identify training needs that meet, support, and incorporate Sedgwick business needs, objectives, strategies, and policies.
• Designs and coordinates detailed training programs for claims management related to products.
• Designs, delivers, and maintains courses for classroom or online application.
• Assists with the implementation of policies and procedures related to various training and educational programs for Sedgwick University.
• Monitors and evaluates the effectiveness of curriculum by deploying measurement and feedback tools that track outcomes and ensure alignment to business objectives.
• Maintains product knowledge, industry knowledge, and familiarity with claim management internal processes.
• Initiates performance consulting process addressing training issues; provides recommendations to internal and external client issues.
• Establishes relationships and networks with a broad range of people and groups for technical claims related areas.
• Creates and maintains assessment and evaluation tools used consistently for external and internal clients.
• Creates reports including management summaries and status reports on various training or client issues or initiatives.
• Modifies, revises, and updates the content of existing training programs.
• Performs other duties as required.
• Supports the organization's quality program(s).
• Travels as required.

Senior Training Consultant – Workers Compensation

Appraiser

• To handle field appraisal assignments for our corporate fleets and insurance clients with an emphasis on Auto's.
• Set appointments same day, inspect within 24 hours and write estimate car side
• Negotiate agreed price with shop decision maker and set time bound expected completion date per Client Guidelines
• Proactively provide customers with information regarding their vehicle’s cost of repair estimate and explain claims/repair process
• Provide extraordinary customer service to all parties involved in the claims process

Field Staff Auto Appraiser

Claims Specialist

• 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.
• 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.

Claims Adjuster – Auto, Temporary

Adjuster

• Handle losses and claims for property and casualty insurers
• Examine insurance policies and other records to determine insurance coverage
• Interview, telephone, and/or correspond with claimant and witnesses regarding claim
• Consult police and hospital records and inspect property damage to determine extent of company's liability and varying methods of investigation according to type of insurance
• Estimate cost of repair, replacement, or compensation
• Prepare report of findings and negotiate settlement with claimant
• Recommend litigation by legal department when settlement cannot be negotiated
• Attend litigation hearings
• Revise case reserves in assigned claims files to cover probable costs
• Assist in preparing loss experience report to help determine profitability and calculate adequate future rates

Examiner

• Responsible for end‑to‑end management of complex general liability claims, from investigation through resolution, ensuring accurate liability assessment and timely outcomes.
• Oversees reserve strategy, settlement negotiations, payments, and statutory filings while maintaining compliance with authority levels and regulatory requirements.
• Manages litigation, vendor partnerships, excess carrier reporting, and recovery efforts to drive cost‑effective claim resolution.
• Serves as a primary point of contact for claimants and clients, maintaining clear communication, strong relationships, and well‑documented claim files.
• Collaborates with leadership to escalate complex matters appropriately and support strategic claim handling decisions.

Claim Examiner – General Liability and Product Liability

Infrastructure Engineer

• Design and maintain robust, scalable security architecture globally for cloud and/or on-premise systems.
• Provide technical guidance on how to design security devices, networks, applications and systems compliant with the requirements of a desired security posture or state.
• Maintain expert knowledge of network and system security principles (i.e. Defense in depth, granularity of privilege) and how they are applied in the standard data center and cloud domain.
• Demonstrate expert knowledge of and provides guidance on modern network security technologies such as network forensics, sandboxing, threat intelligence, network and host-based intrusion prevention, vulnerability assessment, DDOS protection, Security Information Management, and cloud security.
• Provide leadership, mentorship and advisory services to infosec, business, and project teams.

IT Security Infrastructure Architect

Team Lead

• Supervises the operation of a team of examiners for liability claims for clients.
• Identifies and advises management of trends, problems, and issues as well as recommended course of action.
• Provides technical/jurisdictional direction to examiner reports on claims adjudication.
• Compiles reviews and analyzes management reports and takes appropriate action.
• Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
• Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests.
• Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
• Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
• Maintains contact with the client on claims and promotes a professional client relationship.
• Assures that direct reports are properly licensed in the jurisdictions serviced.

Liability Claims Team Lead – General Liability

• 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 I

Representative

• Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments
• Medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations
• Coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors
• Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan
• Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan
• Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines
• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed
• Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
• Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system
• Communicates with the claimants’ providers to set expectations regarding return to work
• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions
• Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system
• Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims
• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities
• Negotiates return to work with or without job accommodations via the claimant’s physician and employer
• Refers cases to team lead and clinical case management for additional review when appropriate
• Maintains professional client relationships and provides excellent customer service

Senior Disability Representative

• To negotiate, facilitate and monitor successful return-to-work of claimants within appropriate disability duration guidelines
• Determines objective, quantifiable, medically supported work restrictions for assigned claims
• Facilitates return-to-work (RTW) and accommodation efforts through negotiation with client, treatment provider and claimant; completes all accommodation/RTW related jurisdictional or client directed documentation, notification, or reporting; and documents client contact in claim notes as per Sedgwick CMS standards

Return-to-Work Representative

Project Manager

• Complete implementation of client programs
• Facilitate transition to field operations and account management colleagues at the conclusion of the project
• Participate in oral presentations
• Prepare and manage project plan through conclusion
• Identify required resources
• Assign duties/responsibilities to team participants
• Communicate activity progress to involved parties
• Resolve issues that arise
• Distribute minutes of meetings timely and accurately
• Responsible for smooth transition of program to permanent colleagues
• Possesses complete understanding of program design, processes, client expectations and partner relationships
• Supports the organization's policies and programs
• Perform other duties as assigned
• Supports the organization's quality program(s)

Implementation Project Manager

• Investigate claims against insurance or other companies for personal, casualty, or property loss or damages
• Attempt to effect out-of-court settlement with claimant
• Handle complex losses locally unassisted up to designated authority
• Assist on larger losses, including handling accounting-based losses (business interruption and stock)
• Examine claim form and other records to determine insurance coverage
• Interview, telephone, or correspond with claimant and witnesses regarding claim
• Consult police and hospital records; and inspect property damage to determine extent of company's liability
• Estimate cost of repair, replacement, or compensation
• Prepare report of findings and negotiate settlement with claimant
• Recommend litigation by legal department when settlement cannot be negotiated
• Attend litigation hearings
• Revise case reserves in assigned claims files to cover probable costs
• Assist in preparing loss experience report to help determine profitability and calculates adequate future rates

General Adjuster

Operations

• Responsible for overall operations management for all assigned locations/offices
• Establishes policy and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements
• Establishes business plan with goals and objectives for the partnership and locations/offices
• Monitors management reports relating to the partner/office performance
• Assists with the coordination of sales and client service efforts
• Performs other duties as assigned
• Supports the organization's quality program(s)
• Travels as required

Director of Operations

General

• Handle losses or claims regionally unassisted up to $10M.
• Address most complex adjustment issues pertaining to damages and coverage.
• Assist on larger losses and manage smaller and non-complex National Accounts.
• Examine claim forms and other records to determine insurance coverage.
• Administer and reconcile complex catastrophic claims for property.
• Interview claimants and witnesses regarding the claim.
• Consult police and hospital records and inspect property damage.
• Estimate cost of repair, replacement, or compensation.
• Prepare report of findings and negotiate settlement with claimant.
• Recommend litigation by legal department when settlement cannot be negotiated.
• Attend litigation hearings.
• Revise case reserves in assigned claims files.

Regional General Adjuster

• To analyze reported lower-level level general liability claims to determine benefits due; and to 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.