Sedgwick

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
• 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

Claims Examiner – Workers Compensation

Business Development Rep

• To expand and enhance the company's top line through diligent relationship building and maintenance with prospective clients across an area
• To identify and address prospective and existing client opportunities for marketing the company's programs
• To ensure sales goals, objectives and profit margins are met
• Identifies, develops and maintains internal and external relationships/partnerships
• Builds relationships with prospects
• Facilitates the development of new partnerships and the company; facilitates and remains involved in the implementation process ensuring a smooth transition of new client programs
• Develops the detailed knowledge of individual prospect operations targeting specific needs which may be opportunities for marketing company programs
• Ensures the identification of expertise required addressing individual prospect requirements; identifies resources for prospect solicitation and service teams
• Utilizes the appropriate national resources to facilitate responses and pricing for RFPs, proposals, and presentations
• Manages the design of service programs ensuring client need fulfillment
• Develops and implements an annual sales and service plan including identification of potential client prospects, their needs, and the methodology of presenting company's ability to fulfill those needs

Vice President, Business Development

• 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

Claims Examiner – Liability, BI and Litigation

• 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
• Prepares necessary state fillings within statutory limits
• Manages the litigation process; ensures timely and cost effective claims resolution
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner

Claims Examiner – Liability, Litigation Experience

• 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.

Claims Adjuster – Bodily Injury, Licensing: FL, TX, GA preferred

Manager

• To provide strategic planning, including product and service development and deployment;
• To manage software development activities;
• To coordinate software development activities with Corporate management and business sponsors;
• To provide administrative guidance and controls ensuring availability and productivity;
• To monitor, manage and evaluate third party technology vendors, products and services.
• Directs assessment, development and deployment of software application development and support services within designated areas of responsibility.
• Coordinates and collaborates software development and support efforts with IT management and stakeholders, including clients.
• Works with implementation and strategic planning to support efficient technology selection, development and deployment for Company and client use; serves as senior management liaison with other departments.
• Provides technology vision and leadership for developing and implementing software development, application support services and vendor management initiatives to improve cost effectiveness, service quality and business development; manages cost-benefit analysis and prioritization change requests.
• Manages and develops software development and vendor management strategic plans within designated areas of responsibility; defines vision for meeting application development and technology support needs; ensures alignment and integration of products and services meet Company vision, mission and values.
• Manages budgeting, staffing and colleague development within designated areas of responsibility.
• Manages technology and methodologies including maintenance of current technology, research and development of new technologies, product design and deployment, and evaluation of industry studies and business development support.
• Ensures confidentiality of Corporate and client data.
• Provides activity reports to IT management for software development, system support, third party vendors, client and prospective clients.
• Sets priorities, establishes goals, ensures deadlines are met, and provides expertise for colleagues and third party vendors within designated areas of responsibility.

IT Applications Manager

• 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.

Claims Examiner – Workers Compensation, Licensed in CT/RI, Exp in CT, MA, RI, NH

• To analyze 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 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.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Ensures claim files are properly documented and claims coding is correct.
• Maintains professional client relationships.

General Liability Claims Adjuster

QA Engineer

• Assess performance of internal, client or vendor case files or records
• Identify trends and areas of opportunity for increased service efficiency and quality
• Work in partnership with stakeholders to ensure all required and relevant data elements are accurately captured
• Compile audit results and submit to manager for review
• Provide audit results for quarterly stewardship reports
• Monitor ongoing action items logs and project plans with appropriate stakeholders
• Update vendor resources to mapping program

Quality Assurance Specialist

Vice President

• 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.

AVP Claims

Consultant

• To handle complex or high exposure claim issues; to provide medical knowledge of the health care system and health care issues;
• to independently investigate, analyze and evaluate medical malpractice claims for self-insured and commercially insured clients;
• to provide information needed to clients as needed to determine liability issues and exposure;
• assist in identification of risk management issues to decrease liability exposure and associated legal costs.
• Handles complex or high exposure claim issues; advises and leads Nurse Consultant - PL colleagues.
• Receives requests for investigation; reviews and develops action plans and investigates cases accordingly.
• Collects data from Company and clients to document and communicate results as appropriate.
• Prepares reports summarizing medical records and interviews; outlines issues related to summary reports; and provides analysis and recommendations for further claims handling.
• Interviews practitioners involved in medical malpractice claims at hospital facilities weekly as needed.
• Participates in follow-up review and investigation as directed and assists in discovery requests as needed.

Senior Professional Liability Nurse Consultant – PRN

• 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 Examiner – Lost-Time Experience, NY Licensing Required

Human Resources

• Leads the CR Shared Services team in executing strategic priorities aligned with organizational goals and global standards.
• Oversees design, implementation, and continuous improvement of processes and technology to enhance efficiency and scalability.
• Builds and develops a high-performing team; fosters leadership capability and succession planning.
• Establishes analytics and reporting frameworks; leverages insights to inform decisions and optimize service delivery.
• Collaborates with SVP, Shared Services and international stakeholders to harmonize processes and ensure a consistent colleague experience.
• Drives automation, self-service, and innovative solutions to elevate service delivery.

AVP, Human Resources Shared Services

• Analyzes and processes complex or technically difficult medical malpractice 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.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with 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.
• Delegates work and mentors assigned staff.

Claims Specialist, Professional Liability – Medical Malpractice

• Analyze reported less complex workers compensation claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
• Support other claims representatives, examiners and leads with larger or more complex claims as necessary