Sedgwick

Clinical Specialist

• Perform standard clinical evaluations and reviews of disability claims requiring additional review based on medical condition, client requirements, or complexity
• Review medical documentation and apply clinical knowledge to substantiate disability and interpret impacts on job functions
• Communicate with employees and providers by phone and in writing regarding clinical status, progress, and work status
• Provide follow-up recommendations for ongoing medical management of claims
• Achieve appropriate quality audit scores
• Act as a clinical resource to claims examiners on medical terminology, medical management, and claim decisions
• Provide backup for key disability claims on an ad hoc basis
• Perform other assigned duties
• Travel as required

Disability Clinical Specialist

Examiner

• Address and handle high-end General Liability cases involving serious injuries, complex coverage scenarios, and legal inquiries or disputes
• Develop strategies to bring cases to satisfactory resolution
• Review and act on reports/forms and respond to inquiries
• Seek legal opinions and early resolution, and communicate resolutions to appropriate parties
• Respond to decisions, agreements, and/or court orders; create action plans; determine need for examination; gain client authorization
• Identify cases for settlements/redemptions
• Gather and document additional information and coordinate with client designees
• Request legal/private investigations; assign to and coordinate with local counsel; monitor local counsel performance
• Respond to plaintiff's counsel, union, employee, or client requests
• Identify issues and formulate defense strategies
• Establish/adjust accrued liability and approve administrative expenses
• Identify subrogation opportunities and manage the process
• Attend and participate in mediations, trials, arbitrations, or hearings as needed
• Work with partners to affect early return-to-work
• Perform other duties as assigned
• Support the organization's quality programs

Litigation Examiner – General Liability

• Perform standard clinical evaluations and reviews of referred disability claims
• Review medical documentation and apply clinical knowledge to substantiate disability and assess impact on job functions
• Communicate with employees and providers regarding clinical status, progress, and work status
• Provide follow-up recommendations for ongoing medical management of claims
• Achieve appropriate quality audit scores
• Act as a clinical resource to claims examiners on medical management, terminology, and claim decisions
• Provide backup for key disability claims on an ad hoc basis
• Perform other assigned duties
• Travel as required

Vice President

• Oversee overall operations management for all locations/offices within an area
• Establish and ensure compliance with best practices, claims management services standards, state regulations, and client service requirements
• Establish business plans with goals and objectives for the area and locations/offices
• Monitor and take appropriate action on management reports relating to area/office performance
• Assist with coordination of sales and client service efforts
• Handle staffing and training needs within assigned offices
• Support staff development, career and succession planning
• Prepare budgets and manage profit and loss for assigned offices
• Administer company personnel policies and follow staffing standards and training recommendations
• Interview, hire, and establish colleague performance development plans
• Conduct colleague performance reviews
• Provide support, guidance, leadership, and motivation
• Support the organization's quality programs
• Travel as required
• Perform other duties as assigned

Vice President, Workers Compensation

Product Manager

• Set product vision and roadmap
• Conduct internal and external discovery to identify client needs, market opportunities, and business priorities
• Incorporate technical constraints, platform standards, and architectural considerations into product direction
• Collaborate with Operations, Sales, and Product leadership to ensure strategic alignment and secure sign-off on key business decisions
• Adjust scope, sequencing, and roadmap decisions with the Product Director
• Define product outcomes and represent the voice of the client
• Communicate roadmap progress, risks, and dependencies to stakeholders
• Estimate effort and allocate capacity
• Define business and functional requirements with Product Management and stakeholders
• Define user stories and acceptance criteria and prioritize the backlog
• Communicate product strategy, requirements, and priorities to development teams
• Coordinate intra-team and external dependencies
• Collect, track, and report KPI data
• Represent the development team for core delivery, non-functional requirements, maintenance, support, and technical initiatives
• Participate in sprint ceremonies, planning, reviews, retrospectives, and evaluation meetings
• Author IT and product documentation
• Maintain understanding of business processes and internal system configurations
• Assess business process changes and system impacts
• Serve as primary stakeholder contact
• Provide product expertise and support for release readiness, lifecycle management, and continuous improvement
• Perform other duties as assigned

Product Manager – Resource Platform

Claims Specialist

• Analyze and process complex or technically difficult general liability claims
• Investigate and gather information to determine claim exposure
• Manage claims through action plans to timely and appropriate resolution
• Manage the litigation process and ensure cost-effective claims resolution
• Coordinate vendor referrals for additional investigation or litigation management
• Lead team meetings and assign accountability for follow-up items
• Gather compliance and claims processing information for team meetings
• Assist in interviewing adjusters and clerical staff and provide feedback to the hiring manager
• Support the team lead with monthly reviews of adjuster workloads, identify trends, and suggest adjustments
• May supervise up to three direct reports
• Administer company personnel policies and follow staffing and training standards
• Interview, hire, establish performance development plans, and conduct performance discussions
• Provide support, guidance, leadership, and motivation to promote maximum performance

Claims Examiner - Liability

• Analyze complex or technically difficult workers' compensation claims to determine benefits due
• Investigate claims and gather information to determine claim exposure
• Manage claims through action plans to timely and appropriate resolution
• Negotiate claim settlements within designated authority
• Calculate and assign reserves and manage reserve adequacy throughout the claim lifecycle
• Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority
• Prepare necessary state filings within statutory limits
• Manage litigation processes for timely and cost-effective resolution
• Coordinate vendor referrals for investigation and litigation management
• Apply cost containment techniques and strategic vendor partnerships
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
• Report claims to excess carriers and respond to requests for direction
• Communicate claim activity and processing with claimants and clients
• Maintain professional client relationships
• Ensure claim files are documented and claims coding is correct
• Refer cases to supervisors and management when appropriate

Workers Compensation Claims Examiner

Manager

• Partner with injured workers, employers, and medical providers to create case management strategies
• Facilitate medical recovery and successful return to work through advocacy, communication, and coordination of medical services
• Perform initial and ongoing clinical assessments by telephone
• Evaluate injuries, medical treatment, psychosocial needs, cultural implications, and support systems
• Communicate and build relationships with claims examiners, clients, injured workers, attorneys, and supervisors
• Identify delayed recovery and return-to-work issues and develop solutions
• Negotiate treatment and disability duration with providers using medical and disability-duration guidelines
• Identify opportunities to expedite care for cost containment and timely recovery
• Recommend alternative clinical resources to support claim resolution
• Maintain client privacy and confidentiality, promote safety and advocacy, and comply with ethical, legal, accreditation, and regulatory standards

Case Manager

• Analyze General Liability and Bodily Injury claims on behalf of clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
• Process claims through action plans toward appropriate and timely resolution
• Investigate claims and gather information to determine claim exposure
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to excess carriers
• Respond professionally and promptly to requests for directions

Claims Examiner – Liability, GL & BI

Data Scientist

• Partner with stakeholders to identify, scope, and execute advanced analytics and data science projects
• Design data modeling processes, algorithms, and predictive models
• Build, prototype, and deploy machine learning models in production environments
• Collaborate with product, technology, and other stakeholders to identify and scope data science projects
• Communicate modeling challenges, findings, and outcomes to technical and non-technical stakeholders
• Design and implement end-to-end ETL data pipelines integrating data from multiple data sources
• Explore new internal and external data sources and assess their commercial benefit
• Mentor team members and serve as a subject matter expert in cross-functional discussions
• Perform other duties as assigned
• Travel as required

Senior Data Scientist

Team Lead

• Supervise multiple teams of examiners, product line examiners, and/or at least seven technical operations colleagues
• Monitor colleagues' workloads and individual claim activities
• Provide training and technical/jurisdictional direction on claims adjudication reports
• Identify and advise management on trends, problems, issues, and recommended actions
• Inform management of new procedures and continuous process improvement ideas
• Coordinate office projects with management
• Compile, review, and analyze management reports and take appropriate action
• Perform quality reviews on claims for audit, service contract, and quality standards compliance
• Act as second level of appeal for client and claimant issues and implement final dispositions
• Review reserves on high-cost claims and claims exceeding examiner authority
• Monitor third-party, litigated, serious vocational rehabilitation, questionable, and sensitive claims
• Maintain client contact, promote professional client relationships, make claim-status recommendations, and provide written claim resumes
• Ensure direct reports are properly licensed in serviced jurisdictions
• Ensure claims files are correctly coded and adequately documented
• Administer personnel policies and staffing standards
• Interview, hire, establish performance development plans, and conduct performance discussions
• Provide support, guidance, leadership, and motivation
• Support organizational quality programs
• Perform other assigned duties

Workers Compensation Team Lead

Analyst

• Perform comprehensive quality reviews of personal and commercial lines claim files with varying severity up to approximately $300,000
• Execute the quality assurance program using Xactimate and Symbility
• Interpret policy and client guidelines to ensure claims compliance
• Guide field colleagues on required revisions
• Complete revisions using Xactimate and/or Symbility
• Document review findings according to team processes
• Identify and provide training and improvement opportunities to the Team Lead
• Coordinate with the Analyst Team on Sedgwick business unit and national quality initiatives
• Provide feedback to the Team Lead for performance management reviews and group training
• Maintain technical claims handling, estimating, and jurisdictional expertise
• Perform other duties as assigned
• Travel as required

Performance Assurance Analyst

• Leads transformation initiatives supporting business unit growth objectives and delivering measurable impact
• Partners with divisional and functional leaders to identify and prioritize enterprise-critical initiatives
• Designs and delivers transformation programs by coordinating cross-functional teams
• Leads process redesign using data-driven thinking and technology enablement
• Identifies, prioritizes, and implements high-impact innovative solutions with technology and business leaders
• Diagnoses root causes, solves complex business problems, and informs data-backed decisions
• Executes change management strategies and engages stakeholders to drive adoption and cultural alignment
• Advises leadership through strategic insight, executive presence, and clear communication
• Tracks outcomes, manages risks, and embeds continuous improvement
• Builds and leads high-performing teams
• Aligns diverse teams around shared goals and enables execution
• Provides guidance, leadership, and motivation
• Administers personnel policies and follows staffing and training recommendations
• Interviews, hires, establishes performance development plans, and conducts performance discussions

VP, Business Transformation

• Supervise multiple teams of examiners and technical staff for liability claims
• Monitor colleagues' workloads and individual claim activities
• Provide training and technical/jurisdictional direction on claims adjudication
• Maintain claim diaries, including frequent diaries for complex or high-exposure claims
• Identify trends, problems, and issues and advise management on recommended actions
• Inform management of new procedures and continuous process improvement ideas
• Coordinate projects with management
• Compile, review, and analyze management reports and take appropriate action
• Perform quality reviews on claims in compliance with audit, service contract, and quality standards
• Act as second level of appeal for client and claimant issues and implement final dispositions
• Review reserve amounts on high-cost claims and claims exceeding examiner authority
• Monitor third-party claims and periodically review litigated, serious vocational rehabilitation, questionable, and sensitive claims
• Maintain client contact and promote professional client relationships
• Make recommendations to clients based on claim status and provide written claim summaries as requested
• Ensure direct reports are properly licensed in serviced jurisdictions
• Ensure claims files are correctly coded and adequately documented
• Administer company personnel policies and follow staffing and training standards
• Interview, hire, and establish colleague performance development plans
• Conduct performance discussions and provide leadership, guidance, support, and motivation
• Support the organization's quality programs
• Perform other duties as assigned

Claims Team Lead – Auto

Director

• Lead enterprise or business unit-wide transformation programs aligned with strategic objectives
• Shape transformation strategy and translate enterprise priorities into executable roadmaps
• Sponsor large-scale AI-enabled process redesign and technology enablement initiatives
• Partner with VPs and executive leaders to align priorities, resources, and outcomes
• Establish enterprise-level governance, success metrics, and benefit realization frameworks
• Drive cultural adoption of data-driven decision-making and continuous improvement
• Ensure transformation outcomes are embedded into operating models
• Serve as a trusted advisor with executive presence and strategic insight
• Provide support, guidance, leadership, and motivation to promote maximum performance
• Administer company personnel policies and follow staffing standards and training recommendations
• Interview, hire, establish colleague performance development plans, and conduct performance discussions
• Travel as required

Disability Clinical Specialist

Litigation Examiner – General Liability

Disability Clinical Specialist

Vice President, Workers Compensation

Product Manager – Resource Platform

Claims Examiner - Liability

Workers Compensation Claims Examiner

Case Manager

Claims Examiner – Liability, GL & BI

Senior Data Scientist

Workers Compensation Team Lead

Performance Assurance Analyst

VP, Business Transformation

Claims Team Lead – Auto

Director, Business Transformation