Sedgwick

Claims Specialist

• Proaktive Regulierung von Schäden zur Reduzierung der Schadenaufwendungen
• Empathisches und souveränes Verhandlungsgeschick im Umgang mit Anspruchstellern, Rechtsanwälten und weiteren Parteien
• Bildung und Überwachung von Schadenreserven
• Prüfung und Durchsetzung von Regressansprüchen
• Begleitung von gerichtlichen Verfahren

Schadenregulierer, KFZ International

Business Development Rep

• Identifies trends and new business areas in claims management
• Works closely with the Marketing Manager Germany
• Develops growth strategies, including initiatives to enter new markets, form partnerships and expand services for clients
• Leads new customer acquisition
• Maintains professional relationship management with national department heads and sales colleagues at the international level
• Defines and builds a key account structure and takes responsibility for partnership management
• Independently and comprehensively manages a defined portfolio of existing clients
• Monitors KPIs and growth targets – analyzes revenue, cost and efficiency metrics and derives recommendations for action
• Works closely with executive management and department heads in a staff/advisory function

Business Development Manager – Germany

Client Services Representative

• To manage accounts of multiple client service programs or single large national program
• To maintain client, client broker and key vendor relationships
• 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

• To analyze workers' compensation 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.
• 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

Project Manager

• To complete implementation of client programs and to facilitate transition to field operations and account management colleagues at the conclusion of the project.
• Participates in oral presentations.
• Prepares and manages project plan through conclusion.
• Identifies required resources.
• Assigns duties/responsibilities to team participants.
• Communicates activity progress to involved parties.
• Resolves issues that arise.
• Distributes minutes of meetings timely and accurately.
• Responsible for smooth transition of program to permanent colleagues.

Project Manager – Implementation

Compliance

• Ensure the company’s regulatory standards compliance
• Track and report state regulatory violations
• Create and maintain relationships with state regulators
• Maintain working knowledge of state regulatory system
• Identify, develop, and assist in delivery of colleague training
• Provide required reporting on claims, penalty and compliance issues
• Act as the primary liaison between company and carrier partners
• Assist in delivery of focused jurisdictional compliance training

Compliance Specialist – Workers Compensation

• Analyze workers' compensation claims on behalf of clients to determine benefits due.
• Ensure ongoing adjudication of claims within service expectations and client service requirements.
• Investigate and gather information to determine the exposure on the claim.
• Negotiate settlement of claims within designated authority.
• Communicate claim activity and processing with the claimant and the client.
• Report claims to the excess carrier and respond to requests in a timely manner.

Workers Compensation Claims Examiner – Dedicated Account

• 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
• 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
• 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

Operations

• To ensure that all data analytical reporting for both internal colleagues and external clients is provided in a timely, effective, and accurate manner;
• to direct staff training and growth;
• and to oversee the overall delivery of all data analytical reporting within the business unit.
• Manages analytical and technical solutions enabling business decisions across the company.
• Oversees the corporate capability for key performance indicators (KPI) and operational reporting.
• Manages the data environment/access for quick computing and complex analytics.
• Executes the business model for Sedgwick's analytics services.
• Serves as point of contact on assigned projects and is responsible for establishing project objectives and policies and performance standards.
• Works with appropriate management on qualitative analysis and value added studies.
• Oversees the work of assigned colleagues, including project assignment and workflow.

Director, Operations Data

• Processes low 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.
• Develops and coordinates low level general liability claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers 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 low-level 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.

Claims Representative – Liability

• Analyze reported lower-level workers compensation claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
• Processes workers compensation claims determining compensability and benefits due
• Communicates claim action/processing with claimant, client and appropriate medical contact
• Maintains professional client relationships

Claims Associate – Workers Compensation

• 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.
• 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.
• 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.

Claims Adjuster - Liability, GL, BI, Auto, PD

Billing Specialist

• Provide general billing / collections support to ensure effective invoicing of all client bills
• Quality check hotel folios and send partial/final invoices to adjusters.
• Research problem folios and resolve with Hotels.
• Produce bi-monthly adjuster housing billing for adjuster placements.
• Reconcile VISA and AMEX hotel charges downloaded into TAAccess.
• Review hotel charges vs. billed income to ensure all hotel stays are profitable.
• Confirm all necessary adjuster approvals are notated in file.
• Assist in adding abatement charges to insured ledger.
• Assist with quality checking and billing of long-term placements as needed.

• To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
• Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.

Claims Examiner, Bodily Injury – Auto

• 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 for directions in a professional and timely manner.