Sedgwick

Claims Specialist

• 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, Southeast State Experience Required, FL Experience Required

Customer Support

• Expedite the Customer Service claims application process
• Ensure correct case assignment
• Act as a customer liaison in assisting the customer with the correct contact person to resolve problems and/or questions
• Assign new claims to the appropriate claims handler
• Enter verbal and written application information into the claims management system
• Communicate clearly and professionally with the customer regarding all aspects of the claims process

Customer Service Associate – Call Center

Consultant

• To establish and maintain client, federal, and state program quality and compliance through thoughtful and accurate program configuration
• Facilitates discussions with clients during implementation and as program changes are required over time, ensuring benefits are understood and properly documented and configured.
• Analyzes client and federal/state benefits; makes recommendations regarding configuration and process options.
• Maintains and verifies client and federal/state benefit parameters in the claims management system and researches issues to resolution.
• Completes client data conversions by analyzing client / vendor files, mapping to standard templates, and working with vendors within expected timeframes set by Implementation.
• Maintains complete understanding of program design, processes, client expectations and partner relationships; makes recommendations for improvements
• Plays a key role in maintaining client relationships, assists in new business productions, and represents Company with specified industry groups.

Business Consultant, Program Configuration

Liability Claims Examiner – GL & Auto, BI & PD

Program Manager

• Manage all aspects of client’s large-loss and high-profile worker’s compensation program to ensure regulatory compliance and that contractual performance standards are met by their third-party administrators (TPAs).
• Provide members with a resource for workers’ compensation information that helps them better understand the complexities of the system.
• Conduct large-loss and high-profile case monitoring, on-site, on-line and by report.
• Research and manage the RFP process for third party administrators (TPA) services based on client needs for their Workers Compensation program.
• Ensure compliance with performance standards/requirements and compliance with all state, federal and regulatory reporting requirements.
• Maintain client relationships by monitoring ancillary vendors and addressing service concerns with providers.
• Conduct oversight reviews for adherence to contract compliance, technical standards, and regulatory requirements.
• Identify and develop training programs specifically related to oversight needs.
• Manage the program for excess claims to include accurate and current reporting, reserves, compliance, payments, and settlement.
• Monitor legislation and changes in state and federal laws while working with clients on impacts to their workers’ compensation programs or services provided by their TPA.
• Present at client board meetings, association, or other public events.

Workers' Compensation Claims Program Manager

Attorney

Liability Claims Examiner – Premise Bodily Injury, Attorney Representative

Support Engineer

• Supports the stability and effectiveness of Sedgwick’s integrations with BillReviewIQ solutions by monitoring system activity, triaging issues, and ensuring timely resolution of data and workflow errors.
• Performs root‑cause analysis, collaborates across technical and operational teams, documents processes, and contributes to ongoing improvements in integration performance, operational readiness, and end‑to‑end legal e‑billing workflows.
• Investigates issues related to system integrations between Sedgwick’s claims platform and BillReviewIQ solutions (Legal X and Legal Exchange).
• Analyzes errors involving case creation, invoice processing, approvals, and payment data exchange.
• Determines whether issues originate in the claims system, BillReviewIQ applications, or the integration layer.
• Traces data from source claims systems through BillReviewIQ workflows to identify gaps, mismatches, or processing failures.
• Reviews system logs, error messages, and transaction data to assess root cause, severity, and operational impact.
• Partners with engineering, product, and operations teams to define fixes, validate corrective actions, and support implementation.
• Leads strategies to deliver cross‑functional training on BillReviewIQ processes and drives adoption of training for teams participating in implementations.
• Coordinates issue resolution efforts with internal Sedgwick teams, including claims technology, claims operations, product, and engineering.
• Serves as a knowledgeable point of contact for integration‑related questions, escalations, and workflow clarifications.
• Identifies recurring issues and systemic trends to recommend improvements to integrations, monitoring practices, and operational workflows.
• Documents integration processes, common failure scenarios, troubleshooting approaches, and resolution steps.
• Enhances operational readiness by contributing to improved alerts, dashboards, knowledge articles, and support playbooks.
• Supports production issues affecting legal e‑billing workflows, financial transactions, and payment processing.
• Participates in incident management activities, post‑incident reviews, and development of preventive action plans.
• Ensures all claims and legal billing data is managed in compliance with company policies, security standards, and data handling requirements.

Application Support Analyst, Legal E-Billing

• Analyze mid- and higher-level general liability claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Identify subrogation of claims and negotiate settlements.
• Manage mid-level general liability claims by gathering information to determine liability exposure.
• Approve and process assigned claims, determine benefits due, and manage action plan.
• Communicate claim action with claimant and client.
• Maintain professional client relationships.

Claims Adjuster – Liability, Auto/Property Damage Experience Required

Workers Compensation Claims Examiner

Client Services Representative

• Manage client renewals, service instructions, pricing, reporting, and contracts for assigned accounts.
• Serve as the primary client contact, driving customer satisfaction and retention.
• Oversee invoicing, audits, and accounts receivable follow-up.
• Analyze and communicate loss data and cost drivers to clients.
• Coordinate projects, identify service issues, and support cross-selling opportunities.
• Lead and develop team members, including hiring, performance management, and coaching.
• Support quality initiatives and perform additional duties as needed.
• Travel as required.

Client Service Manager, California Workers Compensation

Director

• 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.

Claims Director

Therapist

• Counsels providers (physical therapists, occupational therapists, and physicians) as it pertains to the appropriate use, cadence, and duration of physical therapy services.
• Monitors the impact of physical therapy services provided to injured workers.
• Provides medical necessity reviews to evaluate and implement services to meet client health needs.
• Promotes quality cost-effective physical therapy outcomes.
• Reviews medical records and physical therapy (PT) treatment plans to ensure they meet the appropriate guidelines while also ensuring best possible recovery.
• Determines the medical necessity and appropriateness of physical therapy services according to policy and develops action plans for providers as it pertains to current and future treatment.
• Provides clinical opinions regarding physical therapy needs and communicates with providers about therapy protocols and guidelines.
• Liaises and negotiates with physical therapists, occupational therapists, physicians, and other stakeholders to optimize patient care and promote effective use of resources.
• Consults with Sedgwick clinical team on difficult claims and provides recommendations tied to improving care and overall claim outcomes.
• Supports clinical product innovation for Sedgwick in conjunction with both internal and external stakeholders.
• Documents all communications, decisions, and steps taken in the claim process in a timely and accurate manner.
• Participates in client meetings and phone calls to explain program results.
• Supports complex claim roundtable discussions.
• Participates in quality assurance activities, including audits and peer reviews, to ensure adherence to clinical guidelines and standards, as well as identifying opportunities for improvement.
• Stays updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and regulations.

Physical Therapy Case Manager

• Analyze complex or technically difficult workers' compensation 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
• Communicate claim activity and processing with the claimant and the client; maintains professional client relationships

Claims Examiner – Workers Comp

Administrative Assistant

• Provide administrative support including preparing correspondence and reports, filing, and other general office support activities.
• Produces correspondence, reports, and other documentation; files documents, maintains and tracks suspense file, photocopies, etc.
• Provides back-up telephone support.
• Processes invoices and billings; maintains records.
• Maintains unit attendance records, library and/or manuals.
• Records meeting minutes.
• Makes travel arrangements.
• Maintains adequate supply inventory; orders supplies as needed.

• 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