Sedgwick

Underwriter

• Provide property, liability and/or workers' compensation underwriting and related services to clients and/or marketers within delegated authority.
• Analyzes, rates and approves underwriting referrals in a timely manner according to underwriting authority.
• Liaises with assigned customers and is responsible for timely and professional responses to underwriting/related requests and questions.
• Maintains detailed underwriting records.
• Reviews submissions and referrals with supervisor or designated underwriting referral contact as needed.
• Acts as a liaison with other departments and partners including customers, Sedgwick/Pools, claims, loss control, and accounting departments as well as reinsurers and marketers.
• Assists in analytical and administrative projects as assigned.

Underwriting Analyst – Property and Casualty

Software Engineer

• To design and maintain robust, scalable software architecture for one or more elements of CMS software systems;
• To oversee programming, implementation and maintenance revisions of specified projects;
• To evaluate technologies and provide consultation regarding applications and systems needs related to these elements.
• Ensures software scalability and data integrity throughout all claims-related applications.
• Ensures software compatibility and alignment with overall business, IT and infrastructure strategies.
• Identifies and directs implementation of strategies for maintaining JURIS data and application integration.
• Collaborates with management and colleagues throughout CMS and develops overall designs and defines projects for implementation of strategic technology initiatives.
• Consults with project managers to keep informed of active and future projects and to identify areas of overlap.
• Assists as needed in implementation of large client programs involving numerous interfaces or system modifications.
• Manages analyst/programmers as needed.

IT Software Development Advisor

Client Services Representative

• Performs contract renewal and Client Service Instruction preparation for assigned accounts.
• Coordinates renewal pricing and completes location coding parameters; prepares and distributes stewardship and other reports.
• Educates the client on loss data - drivers of cost impacting assigned programs.
• Coordinates project activity.
• Acts as primary client contact with focus on maintaining and improving overall customer satisfaction.
• Identifies issues that impact consistency and customer satisfaction; works with program management leadership to effect problem resolution; and assists with identifying office level service trends and establishes plans for service improvement.
• Identifies and solicits cross selling opportunities.

Client Services Representative, WC Experience Preferred

Claims Specialist

• To analyze workers' compensation claims on behalf of our valued clients.
• Determine benefits due, while ensuring ongoing adjudication of claims within service expectations.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.

Workers Compensation Claims Examiner

Manager

• Ensures adherence to client service instructions.
• Monitors client reserves for accurate reflection of client's book of claims; ensures reserves are within an appropriate range.
• Tracks and trends performance guarantee and gain share agreements at the client level.
• Ensures client's claims reports are properly and timely prepared and distributed.
• Monitors client's average cost of claims; identifies trends and excessive cost factors.
• Conducts client specific operational audits; monitors client audit compliance.
• Works with company Quality and Operations staff to resolve client issues including results of client Compass audits.
• Manages client specific internal control report issues.
• Ensures timely payment of TTD, medical and vendor bills; ensures appropriate vendor utilization.
• Reviews aging claims for file closure ensuring claims do not age beyond appropriate time frames.

Client Performance Manager

Systems Engineer

• To lead the business analysis efforts for implementations and large, multi-line projects.
• To review, analyze and document internal and client user needs.
• To provide mentorship and leadership within the business analysis team.
• Leads the requirements management efforts for large projects to include new client implementations (client facing) and large strategic projects.
• Devises and executes a requirements management plan for assigned projects.
• Takes ownership of the business analysis role throughout the project.
• Identifies and understands stakeholders; initiates and facilitates meetings and discussions with stakeholders as appropriate.
• Works with project managers, project requestors, operations, business representatives, IT representatives and clients to ensure complete understanding of software requirements.
• Provides business related IT knowledge to clients and business representatives during the requirements management process.
• Produces project requirements documentation, including written documents, process diagrams, report mock-ups, wire frames and other documentation as required, using standard templates.
• Meets deadlines and manages work to timelines.
• Mentors team members.

Senior IT Systems Analyst Specialist

• To analyze and process low to mid-level auto and transportation claims
• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution
• Identifies and pursues subrogation opportunities; secures and disposes of salvage
• Communicates claim action/processing with insured, client, and agent or broker when appropriate
• Maintains professional client relations
• Performs coverage, liability, and damage analysis on all claims assignments

Claims Representative, Auto

• 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
• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim
• Manage claims through well-developed action plans to an appropriate and timely resolution
• Negotiate settlement of claims within designated authority
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim
• Prepare necessary state fillings within statutory limits
• Manage the litigation process; ensure timely and cost-effective claims resolution
• Coordinate vendor referrals for additional investigation and/or litigation management
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
• Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
• Report claims to the excess carrier; respond to requests of directions in a professional and timely manner
• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships
• Ensure claim files are properly documented and claims coding is correct
• Refer cases as appropriate to supervisor and management

WC Claims Examiner – Dedicated Client, MD Jurisdiction

• Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim.
• Assesses liability and resolves claims within evaluation.
• Negotiates settlement of claims within designated authority.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments.
• 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.

Claims Adjuster – Liability, FL/TX/NY preferred

Project Manager

• To develop and manage project assignments through completion; to communicate results; to communicate results; to make recommendations to management; and to provide training.
• Identifies required resources; researches project data, procedures and history for a thorough understanding of project direction.
• Generates and analyzes statistical data reports.
• Develops, prepares and manages project plan through completion.
• Communicates activity progress to involved parties.
• Resolves issues that arise involving client, when appropriate.
• Transitions program to management personnel.
• Participates in oral presentations.
• Develops and provides training to management and colleagues as needed.
• Supports the organization's quality program(s).
• Travels as required.

IT Project Management Advisor

• Gérer et traiter les réclamations attribuées tout en respectant les normes de qualité de l’entreprise
• Mener des enquêtes approfondies, déterminer la couverture et la validité des réclamations
• Interroger et communiquer avec les assurés, les requérants et les témoins
• Inspecter les sites touchés au besoin
• Élaborer des rapports et négocier des règlements dans les limites de l’autorité accordée

Claims Adjuster – Assurance de biens

• Manages/adjusts assigned claims while meeting company standards and quality
• Conducting thorough investigations
• Determining coverage and validity of claims
• Interviewing and communicating with insured, claimants and witnesses
• Inspecting claims sites as required

Claims Adjuster – Multi-line

Consultant

• Manage and support our property claims, end to end.
• Provide exceptional customer services to our clients and customers through proactive claims management.
• Process all claims within your delegated authority.
• Meet, if not exceed, claim deadline as per our service level agreement.
• Ensure compliance with relevant service agreements and Codes.

Commercial Property Claims Consultant

• Analyze complex veterinary claims and provide resolution of highly complex nature and/or severe injury claims
• Coordinate case management within Company standards
• Manage total claim costs while providing high levels of customer service
• Conduct investigations and provide reports on new events, claims and legal actions
• Negotiate claim settlements up to designated authority level
• Calculate, assign and monitor reserves throughout the claim life
• Recommend settlement strategies and coordinate legal defense
• Identify and investigate for possible fraud, recovery, and case management opportunities
• Communicate claim activity with clients and maintain professional relationships
• Ensure claim files are properly documented and claims coding is correct
• Delegate work and mentor assigned staff

Senior Claims Specialist, Veterinary Claims

• 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.
• 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.