Sedgwick

Backend Engineer

• To develop, maintain and support software using expertise in VB.Net, MS SQL, with a willing to learn Salesforce and APEX coding.
• Work in a Windows Server environment using integrated development environments like Visual Studio/Code or similar technologies.
• This role involves supporting existing high transaction applications and data flow between external systems via API/SFTP, middleware processing servers and Salesforce.
• Analyze user needs and assist in designing specifications to meet those needs.
• Develop and modify software based on data processing requests.
• Ensure compliance with insurance carrier and regulatory requirements through software development.
• Test and debug assigned projects; assist in testing projects developed by other team members.
• Prepare and maintain documentation for new and existing software.
• Investigate and resolve escalated support issues, including data and software corrections.
• Troubleshoot and investigate issues that may arise with IIS Servers, SQL Database or network infrastructure.
• Stay current with advancements in programming languages, frameworks, and emerging software development technologies.
• Follow departmental standards and guidelines for software design and development.
• Deliver and maintain high-quality customer service.
• Be a team player and will need to be proactive at problem solving.

VB.Net Middleware Developer

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.

Workers Compensation Claims Examiner – NY Jurisdictional Knowledge, NY Licensing Required

• 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 clams 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).

Workers Compensation Claims Examiner

Operations

• Responsible for overall operational management for assigned locations/offices.
• Establishes policy and procedure to assure compliance to best practices, claims management services standards, state regulations and client service requirements.
• Establishes business plan with goal and objectives for the partnership and assigned locations/offices.
• Monitors management reports relating to the partnership/office performance.
• Assists with the coordination of sales and client service efforts.

Senior Operations Manager

Workers Compensation Claims Examiner – NY Licensing Required

• To analyze Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• 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 Representative – Workers Compensation, MD, VA & DC Jurisdictional Knowledge

Human Resources

• Proactively monitor, manage and triage CR enquiries within SLAs
• Guide and support colleagues to navigate online self service materials and adopt our new Colleague Support Now platform
• Triage high level issues to the appropriate HR team member as necessary (i.e HR Advisor, Team Leader, BP…)
• Manage all employee lifecycle processes end to end from hire to retire.
• Prepare Employee Contracts, Contract Variations and complete the related actions associated with each process.
• Manage compliance processes, including but not limited to compliance training, background checks and site safety training
• Accurately maintain HR records (including staff personnel files and Workday) ensuring data integrity is maintained within our records and systems.
• Support and participate in ad-hoc HR projects and initiatives as required.

HR Administrator

Customer Support

• To 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 that meets both the internal and external customers' requirements accurately into the claims management system
• Contact the customer by telephone, written correspondence and/or the claims system regarding documentation required to process a claim, required time frames and claim status
• Communicate clearly and professionally with the customer regarding all aspects of claims process
• Participate in and maintain a quality service culture within the Customer Service Team
• Attendance during scheduled work hours is required

Entry-Level Bilingual Customer Service and Claims Associate, Spanish and Brazilian Portuguese

• To expedite the Customer Service claims application process; to ensure correct case assignment; and to act as a customer liaison in assisting the customer with the correct contact person to resolve problems and/or questions.
• You will be handling USA and Latin American customers
• Assigns new claims to the appropriate claims handler.
• Enters verbal and written application information that meets both the internal and external customers' requirements accurately into the claims management system.
• Contacts the customer by telephone, written correspondence and/or the claims system regarding documentation required to process a claim, required time frames and claim status.
• Communicates clearly and professionally with the customer by telephone and/or written correspondence regarding all aspects of claims process.
• Participates in and maintains a quality service culture within the Customer Service Team. Attendance during scheduled work hours is required.

Entry-Level Bilingual Customer Service and Claims – Spanish, Brazilian Portuguese

Manager

• Negotiate and/or renegotiate medical contracts for multiple lines of business in managed care markets.
• Grow the network by recruiting new medical groups and facilities as requested by clients and to fill gaps in geographical coverage.
• Analyzes market data and financial models.
• Prepares, negotiates, and administers provider contracts.
• Develops and expands provider participation within the network.
• Documents contracts; updates contracts as changes occur.
• Coordinates customer inquiries.

Contract Manager II

Growth Marketing

• Maintain MCA's competitive edge through effective marketing strategies, branding, innovation, and change management
• Lead the design and development of new multi-functional strategies, processes, products, and solutions
• Provide leadership and assistance in daily operations
• Motivate and manage staff to ensure performance standards are met or exceeded
• Develop, implement, and ensure compliance with policies, procedures, protocols, and quality standards
• Monitor daily productivity, balance workloads, and report on progress toward goals
• Coordinate with business unit leads to implement priorities and goals
• Develop and manage client relationships with MCA's clients

VP Strategic Growth

• Analyzes mid- and higher-level workers compensation claims to determine benefits due.
• Ensures ongoing adjudication of claims within company standards and industry best practices.
• Identifies subrogation of claims and negotiates settlements.
• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims.
• 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.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• Maintains professional client relationships.

Claims Adjuster – Workers Compensation

Bilingual

• Process claims and determine accommodation options following written guidelines and procedures pursuant to ADA
• Make timely referrals for appropriate disability and federal/state leave of absence eligibility review
• Ensure the ongoing processing of claims
• Inform claimants of documentation required to process claims, required time frames, and claims status either by phone, written correspondence and/or claims system
• Review medical information to determine if the claimant meets the requirements under ADA, state, and/or client requirements for a qualifying condition
• Make claim determinations to approve non-complex ADA claims or make a recommendation to team lead to deny claims based on the ADA, state, and/or client requirements
• Process ADA claims ensuring compliance with duration control guidelines, ADA and state regulations, and/or client-specific process provisions
• Determine accommodation options and make timely claims referrals for appropriate disability or federal/state leave of absence eligibility reviews where applicable
• Conduct initial employee interview per process guidelines
• Utilize the appropriate clinical and vocational resources in case assessment
• Refer cases as appropriate to team lead
• Maintain professional client relationships.

Bilingual ADA Accommodation Coordinator – Spanish or Portuguese

• To analyze complex or technically difficult general liability and auto 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.