Sedgwick

Manager

• Sedgwick Field Case Managers work face to face with their injured workers and medical providers to facilitate advocacy, progressive medical treatment, and timely return-to-work.
• 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, ensuring timely and cost-effective resource usage.

RN Field Case Manager

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.
• Ensure sales goals, objectives and profit margins are met.
• Establish an authoritative voice in the industries, driving credibility, trust, and business opportunities by delivering high-impact, original insights to C-suite professionals and senior stakeholders.

Business Development Director

Consultant

• To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications.
• Utilizes special account instructions to obtain individual customer information and adhere to instructions.
• Identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
• Establishes and maintains effective relationship with internal and external customers and coworkers; communicates effectively and timely.
• Mentors/coaches account representatives and account specialists; facilitates round table discussions within the assigned team.
• Investigates, evaluates and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations.
• Interprets medical reports and state law or jurisdictional law in claim handling.
• Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
• Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
• Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve claims.
• Ensures compliance and best possible outcomes by minimizing financial liability.
• Compiles requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines.
• Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.

Account Consultant

Client Services Representative

• Determine account management strategies related to client service plans.
• Responsible for retention of existing clients, customer satisfaction, revenue growth, client surveys, and new business.
• Provide program management for jumbo clients requiring dedicated staff, multiple offices, and complex service models.
• Oversee the work of other local Client Services staff.
• Provides stewardship reporting to clients; identifying and educating clients on issues and trends impacting programs.
• Conduct 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.
• Resolves all major customer service issues.
• Identifies and solicits cross-selling opportunities.
• Participates in local insurance community through advanced education and affiliation memberships.
• Supervises and directs personnel assigned to programs requiring multiple Account Representatives.
• Ensures compliance with all applicable Quality initiatives.

Client Services Director

Compliance

• To perform initial and ongoing clinical assessment through provider outreach, specialized document review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations.
• Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations.
• Uses specialized knowledge to assess the needs of the individual case and creates customized correspondence for any applicable providers.
• Proactively and strategically plans and executes outreach activities with providers via telephone, email, and fax.
• Reviews and analyzes completed documentation from providers.
• Measures interventions to determine the outcome of the clinical assessment involvement.

RN Medicare Compliance – Proactive Reduction Outreach

• Lead a regional Construction expertise agency
• Build and manage a profit center
• Develop strong commercial partnerships
• Manage and improve client service quality
• Recruit and lead a team

Regional Operations Manager – Construction Experts Team

Content Marketing Manager

• To investigate and adjust property and casualty claims, both residential and commercial, with little to no supervision.
• Inspects claims and contacts involved parties in a timely manner.
• Investigates circumstances of claim(s) as required for coverage determination, cause, and compensable damages/reserves.
• Examines insurance policies and other records to determine insurance coverage.
• Prepares estimates for cost of repair and/or replacement.
• Conducts interviews with claimant and witnesses regarding submitted claim(s).
• Negotiates and settles both 1st and 3rd party claims.
• Addresses salvage and subrogation as required by the client.
• Maintains client relationships to assure repeated business referrals.

Contents Adjuster

• To manage accounts of multiple client service programs or single large national program; to maintain client, client broker and key vendor relationships; and to manage program procedures and processes that impact customer satisfaction ensuring consistency in process within the account as well as client retention.
• Performs client renewal and Client Service Instruction preparation for assigned clients.
• Coordinates pricing and completes location coding parameters; prepares and distributes stewardship and other reports.
• Coordinates client invoicing, audits and accounts receivable follow-up for assigned clients.
• Educates the client on loss data - drivers of cost impacting assigned programs.
• Coordinate project activity.
• Acts as primary client contact with focus on maintaining and improving overall customer satisfaction.
• Identifies issues that impact customer satisfaction.
• Identifies and solicits cross selling opportunities.
• Coordinates client contracts.

Client Services Manager

Claims Specialist

• Attendance and completion of designated claims professional training program.
• Adjusting various levels of workers’ compensation claims under close supervision.
• Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
• Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives.
• Thoroughly investigating new and existing claims by gathering relevant information.
• Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
• Documenting claims files and preparing detailed reports documenting findings and recommendations.
• Participating in virtual and/or in-person meetings as needed for educational training and claim discussions.

Claims Representative, Workers Compensation Training Program

Payroll

• Lead design and configuration of PATT modules
• Act as functional lead and decision-maker
• Translate functional requirements into scalable, standardized Workday solution
• Provide feasibility assessments based on system capabilities and constraints
• Ensure compliance with payroll and labor regulations
• Mentor junior analysts

Workday Analyst – Payroll, Absence, Time Tracking – Senior / Lead Level

• To analyze workers compensation claims on behalf of our valued clients to determine benefits due, while 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 Examiner – Workers Compensation I

• 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

Field Case Manager – Vocational

• 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

• Ensures contract compliance with company guidelines within an assigned area
• Handles financials including accounts receivable, invoicing and pricing support within an assigned area
• Responsible for client knowledge including threatened status and relationship with the company
• Handles renewal process timely; negotiates new contracts within an assigned area
• Responsible for business planning and budgeting within an assigned area
• Plans for staffing needs including succession, bench-strength, and new business within an assigned area
• Supports client relationships; builds executive relationships; supports internal relationships
• Supports business development

AVP Client Services – Workforce Absence

• To process low level general liability & bodily injury claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Identify subrogation of claims and negotiate settlements with general supervision.
• 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.