Sedgwick

Representative

• Provides disability case management and complex claim determinations based on medical documentation and disability plan interpretation
• Determines benefits due and makes timely payments, approvals, and adjustments
• Reviews and analyzes complex medical information to determine disability status
• Oversees complex claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines
• Utilizes clinical resources in case assessment
• Informs claimants about required documentation, time frames, payment information, and claim status
• Communicates with claimants’ providers regarding return-to-work expectations
• Medically manages complex disability claims for compliance with duration control guidelines and plan provisions
• Communicates with claimants and clients throughout the claims process
• Coordinates investigations and reviews contested claims
• Refers claims to outside vendors or physician advisors for surveillance, independent medical evaluations, functional capability evaluations, and related activities
• Negotiates return to work with or without accommodations through physicians and employers
• Refers cases for additional team lead and clinical case management review
• Maintains professional client relationships and provides customer service
• Meets organizational quality program requirements
• Performs other duties as assigned

Senior Disability Representative

Claims Assistant

• Provide support to claims staff and perform office tasks depending on the client program
• Input and review notes and diaries in the claims management system
• Answer and initiate telephone calls, set up medical appointments, and provide customer service as required
• Prepare and distribute computer reports
• Set up, assign, reassign, and reopen claims within the claims management system
• Maintain claim data, including policy, coverage, date of loss, date of birth, and account information
• Process letters and other claim-related correspondence
• Upload and manage claim documentation, including legal files, policy documents, and medical records requests
• Process settlement payments, expense invoices, returned checks, and vendor setup requests
• Respond to general emails, phone calls, auditor requests, and stakeholder inquiries
• Generate loss runs and other claims-related reports
• Perform administrative duties including mail processing, filing, scanning, faxing, and report distribution
• Support special projects and perform other assigned duties

Claims Specialist

• Investigate and adjust residential and commercial property and casualty claims with little to no supervision
• Inspect claims and contact involved parties in a timely manner
• Investigate claim circumstances for coverage determination, cause, compensable damages, and reserves
• Examine insurance policies and records to determine coverage
• Prepare repair and replacement cost estimates
• Interview claimants and witnesses
• Negotiate and settle first- and third-party claims
• Address salvage and subrogation as required by the client
• Maintain client relationships to support repeat business referrals
• Support organizational quality programs
• Perform other assigned duties
• Travel as required

Senior Claims Adjuster – Accident Benefits

• Analyze and manage complex or technically challenging general liability claims from inception through resolution
• Conduct investigations to determine liability, damages, and claim exposure
• Develop and execute strategic claim action plans
• Assess liability and negotiate settlements within assigned authority limits
• Calculate, establish, and maintain claim reserves
• Authorize and process claim payments and adjustments within delegated authority
• Ensure compliance with laws, regulations, and client-specific requirements
• Prepare and submit required state filings within statutory deadlines
• Report claims to excess carriers and respond to information or direction requests
• Manage litigated claims in collaboration with defense counsel and external partners
• Coordinate vendor referrals for investigations, medical reviews, surveillance, and litigation management
• Use cost-containment strategies and vendor partnerships to reduce claim costs
• Pursue and manage claim recoveries, including subrogation and applicable offsets
• Communicate proactively with claimants, clients, attorneys, and stakeholders
• Build and maintain client relationships through professional and responsive service
• Accurately document and code claim files
• Escalate complex issues and high-exposure matters to leadership
• Perform other duties as assigned

Claims Examiner – Auto, General Liability, Bodily Injury

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
• Apply medical/clinical or rehabilitation knowledge to manage complex medical conditions, treatment planning, and recovery
• 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 problem-solve creatively
• 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 alternate clinical resources to support claim resolution
• Maintain client privacy and confidentiality, promote client safety and advocacy, and adhere to ethical, legal, accreditation, and regulatory standards

RN, Telephonic Case Manager

Patient Care Coordinator

• Reach out to patients regarding new or processing referrals, confirming demographic information, providing referral updates, and confirming delivery of goods or services
• Communicate with vendor partners, claims adjusters, and nurse case managers about new and in-process referrals
• Procure vendor partners for each referral based on requested goods or services
• Make and take phone calls regarding existing referrals, new referrals, and other team members’ referrals
• Provide quotes to clients for approval and follow up on quotes to obtain written approval
• Ensure referrals are medically necessary and approved by the claim adjuster
• Confirm required billing information and move referrals to billing each day
• Process referrals according to state regulations and workers’ compensation guidelines
• Perform other duties as assigned
• Support the organization’s quality programs
• Travel as required

• Analyze New York Lost-Time Workers Compensation claims on behalf of clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
• Analyze and process claims through action plans by investigating and gathering information to determine claim exposure
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to the excess carrier and respond to direction requests professionally and timely

Workers Compensation Claims Examiner, NY Jurisdiction Experience

Team Lead

• Supervise personal injury protection examiner teams and technical staff for clients
• Monitor colleagues' workloads and individual claim activities
• Provide training and technical/jurisdictional direction on claims adjudication
• Supervise multiple examiner teams, product line examiners, and/or technical operations colleagues
• Identify and advise management on trends, problems, issues, and recommended actions
• Coordinate projects with management and support continuous process improvement
• 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
• Maintain client contact, promote professional client relationships, and provide claim summaries
• Ensure direct reports are properly licensed and claims files are correctly coded and documented
• Administer personnel policies, interview and hire colleagues, establish performance plans, conduct performance discussions, and provide leadership and motivation

Claims Team Lead, Auto – PIP

• Analyze reported lower-level general and bodily injury liability claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Analyze and process claims through action plans to timely resolution
• Investigate and gather information to determine claim exposure
• Handle lower-level liability and/or physical damage claims under close supervision
• Support claims representatives, examiners, and leads with larger or more complex claims
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to the excess carrier and respond to requests for directions

Claims Associate – Liability

Content Marketing Manager

• Work with management on staff development
• Review work and provide diplomatic feedback to maintain quality of work product
• Prepare reports and correspondence to customers, other VeriClaim adjusters, and/or insureds
• Evaluate residential and commercial contents inventories on replacement cost and actual cash value bases
• Apply policy coverage limitations and/or exclusions
• Finalize inventories for reporting, including preparing enclosures, letters, and detailed notes
• Facilitate use of replacement services as requested by the Contents Adjuster
• Review and process replacement receipts
• Communicate courteously and professionally with colleagues, management, customers, and insureds
• Support the organization's quality programs
• Perform other duties as assigned

Content Evaluator Associate

• Analyze workers compensation claims on behalf of clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
• Analyze and process claims through action plans to timely resolution
• Investigate 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 the excess carrier
• Respond to requests for directions professionally and timely

Claims Adjuster – Workers Compensation

• Analyze Auto Property Damage claims on behalf of the dedicated client to determine benefits due
• Process low-level Auto Property Damage claims
• Ensure ongoing adjudication of claims within company standards, industry best practices, service expectations, and client service requirements
• Investigate claims and gather information to determine claim exposure
• Develop action plans to reach appropriate and timely resolutions
• Negotiate claim settlements within designated authority
• Identify subrogation of claims
• Communicate claim activity and processing with claimants and clients
• Report claims to excess carriers
• Respond professionally and promptly to requests for directions

Liability Claims Representative – Auto Property Damage

• Analyze workers compensation claims on behalf of clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
• Analyze and process claims through action plans to timely resolution
• Investigate 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 the excess carrier
• Respond to requests for directions professionally and timely
• Work with autonomy in daily work, location, and career path

Claims Examiner – Workers Compensation

Performance Marketing

• Lead the development and execution of integrated marketing campaigns aligning brand, demand generation, and ABM strategies
• Drive pipeline growth, executive engagement, and strategic account penetration
• Partner with business unit Presidents and their teams to develop growth marketing strategies
• Partner with sales leadership to identify and prioritize strategic accounts
• Collaborate with marketing centers of excellence to deploy marketing tactics
• Provide stakeholder updates and optimize plans based on results and learnings
• Develop best practices and best-in-class marketing approaches with fellow Brand Strategists
• Lead campaigns across awareness, engagement, activation, and sales enablement
• Manage the team marketing budget and Agile Team resources toward high-value growth initiatives
• Coordinate digital, events, content, nurture, webinar, ABM, and sales outreach tactics
• Design and execute account-based marketing programs for target industries, buyer personas, and organizational priorities
• Coordinate personalized outreach programs, landing pages, executive events, and nurture experiences
• Support demand generation and lead capture initiatives tied to MQL, SQL, and pipeline goals
• Manage performance optimization through testing, reporting, and analytics
• Collaborate with creative, communications, digital, analytics, and business teams
• Lead conference and executive event marketing strategy, including pre-event, onsite, and post-event engagement
• Develop campaign briefs, messaging frameworks, KPI definitions, and executive-ready reporting
• Drive continuous optimization across campaign performance, targeting, conversion, and engagement
• Provide support, guidance, leadership, and motivation to promote maximum performance
• Administer company personnel policies and follow staffing and training standards
• Interview, hire, establish performance development plans, and conduct performance discussions
• Perform other duties as assigned

Director, Demand Generation & ABM – Integrated Marketing Strategy

• 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 issues related to delayed recovery or return to work
• Problem-solve using a creative-thinking approach
• Negotiate treatment and disability duration with providers using medical and disability duration guidelines
• Identify opportunities to expedite care for cost containment and timely medical recovery
• Recommend alternate clinical resources to support claim resolution
• Maintain client privacy and confidentiality, promote client safety and advocacy, and follow ethical, legal, accreditation, and regulatory standards