Sedgwick

Claims Specialist

• 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; 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.
• Travels as required.

Claims Examiner – Liability, GL & BI

AI Engineer

• Design and deploy architectures for Generative AI applications
• Build and scale autonomous agents using AWS and Azure
• Define and enforce overall cloud posture for AI initiatives
• Architect Retrieval-Augmented Generation (RAG) systems
• Implement data ingestion from legacy systems
• Partner with teams using advanced analytics platforms
• Ensure AI designs meet governance and security standards
• Oversee feature engineering and statistical validation

AI Architect

Scrum Master

• Ensure structured, predictable, and transparent delivery of AI initiatives supporting insurance and claims operations
• Facilitate all Agile ceremonies, ensuring Sprint Planning sessions reflect realistic capacity and clear objectives
• Work closely with the Product Manager/Owner to confirm backlog readiness
• Monitor delivery health using metrics such as velocity, throughput, cycle time, and unplanned work percentage
• Protect sprint integrity while coordinating appropriate channels for reprioritization
• Identify impediments related to data access, integration constraints, security reviews, model validation processes, or cross-team dependencies
• Reinforce discipline around change management
• Foster continuous improvement by facilitating structured retrospectives
• Encourage psychological safety and shared accountability within the team
• Maintain transparent dashboards and reporting mechanisms

Scrum Master – AI Delivery

Machine Learning Engineer

• Build and maintain automated CI/CD and CT (Continuous Training) pipelines across AWS and Azure
• Design and execute the infrastructure for Retrieval-Augmented Generation (RAG)
• Build engineering 'pipes' to securely ingest and move data from legacy systems
• Implement systemized frameworks for LLM evaluation and traditional ML validation
• Deploy real-time monitoring for model drift, hallucination detection, latency, and token consumption
• Manage all AI resources using Infrastructure as Code (IaC)
• Partner with teams using platforms like Palantir, Databricks, or Snowflake
• Work directly with central IT and Security
• Optimize model serving endpoints for high-throughput and low-latency
• Establish rigorous version control for prompts and model weights
• Automate feature stores and feature engineering pipelines
• Implement automated scanning and guardrails to prevent prompt injection and data leakage

Senior Engineer – LLMOps, MLOps

Project Manager

• Complete implementation of client programs and facilitate transition to field operations
• Prepare and manage project plan through conclusion
• Identify required resources and assign duties/responsibilities to team participants
• Communicate activity progress and resolve issues

Project Manager – Implementation, Disability & Leave

• 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; 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, Auto, Bodily Injury, GL

• 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.

Workers Compensation Claims Adjuster – VA Jurisdiction

• 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
• Investigate and gather information to determine the exposure on the claim
• Assess liability and resolve claims within evaluation
• Negotiate settlement of claims within designated authority
• Calculate and assign timely and appropriate reserves to claims
• Manage reserve adequacy throughout the life of the claim
• Approve and make timely claim payments and adjustments
• Prepare necessary state filings within statutory limits
• Manage the litigation process; ensures timely and cost effective claims resolution
• Communicate claim activity and processing with the claimant and the client; maintains professional client relationships

Claims Examiner, General Liability

• Analyze and process complex auto bodily injury claims by reviewing coverage
• Complete investigations, determine liability, and evaluate the scope of damages
• Coordinate vendor management, including the use of independent adjusters to assist in investigations
• Report large claims to excess carriers
• Develop and maintain action plans to ensure state required contact deadlines are met
• Identify and pursue subrogation and risk transfer opportunities; secure and dispose of salvage
• Communicate claim action/processing with insured, client, and agent or broker when appropriate

Claims Examiner, Bodily Injury, Lit Required, Auto

Operations

• Responsible for overall operations management for all locations/offices within an area
• 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 assigned area and locations/offices
• Monitors management reports relating to the area/office performance
• Assists with the coordination of sales and client service efforts
• Administers company personnel policies in all areas and follows company staffing standards and training recommendations
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance reviews
• Provides support, guidance, leadership and motivation to promote maximum performance

Assistant Vice President – Operations

Consultant

• To address and handle high end cases with serious injuries, complex coverage scenarios and legal inquiries or disputes; to develop a strategy to bring a case to satisfactory resolution.
• Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.
• Handles high end cases with serious injuries and/or complex coverage scenarios.
• Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.
• Identifies cases for settlements/redemptions. Gathers/documents additional information and coordinates with client designees.
• Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.
• Responds to plaintiff's counsel, union, employee, or client requests. Identifies issues and formulates defense strategy.
• Establishes/adjusts accrued liability and approves administrative expenses. Identifies subrogation opportunities and manages process.
• Attends and participates in mediations, trials, arbitrations or hearings as needed.
• Works with partners to affect early return-to-work. Performs other duties as assigned. Supports the organization's quality program(s).

Litigation Consultant – General Liability, Bodily Injury

• 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.
• 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 – Liability, Bodily Injury, Litigation

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

RN Field Case Manager

Client Services Representative

• 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 such as information technology, operations and business development.
• Coordinates client invoicing, audits and accounts receivable follow up for assigned clients.

Client Service Director – Managed Care

• Manages mid-level general liability claims by gathering information to determine liability 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.
• 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).