Sedgwick

Consultant

• Address and handle high-end 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 and forms; respond to inquiries; seek legal opinions and early resolution; 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 and coordinate with local counsel; monitor local counsel performance
• Respond to requests from plaintiff's counsel, unions, employees, or clients
• Identify issues and formulate defense strategies
• Establish or 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 facilitate early return-to-work
• Perform other duties as assigned
• Support the organization's quality programs

Litigation Consultant – General Liability

Representative

• Analyze, approve, and authorize assigned disability claims and determine benefits due under disability plans
• Review complex medical information to determine whether claimants are disabled under the applicable disability plan
• Use clinical resources in case assessment
• Communicate with claimants' providers regarding return-to-work expectations
• Determine benefits, payments, approvals, and adjustments for workers' compensation, SSDI, and other disability offsets
• Medically manage disability claims in compliance with duration control guidelines and plan provisions
• Communicate claims-process information with claimants and clients by phone and written correspondence
• Inform claimants about required documentation, time frames, payment information, and claim status
• Coordinate investigative efforts and review contested claims
• Arrange referrals to outside vendors or physician advisors for surveillance, independent medical evaluations, functional capability evaluations, and related disability activities
• Negotiate return to work with or without accommodations through claimants' physicians and employers
• Refer cases to team leads and clinical case management as appropriate
• Maintain professional client relationships
• Support organizational quality programs
• Perform other assigned duties

Senior Disability Representative

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 issues related to delayed recovery or return to work 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 medical recovery
• Recommend alternate clinical resources to support claim resolution
• Maintain client privacy and confidentiality and promote client safety and advocacy
• Adhere to ethical, legal, accreditation, and regulatory standards

Telephonic Case Manager

Claims Specialist

• 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
• Investigate claims and gather information to determine claim exposure
• Process claims through action plans to timely and appropriate resolution
• 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 workers compensation claims on behalf of valued clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific 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 excess carriers
• Respond professionally and timely to requests for directions

Claims Examiner – Workers Compensation

Client Services Representative

• Determine account management strategies related to client service plans
• Retain existing clients and drive 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
• Provide stewardship reporting and educate clients on issues and trends impacting programs
• Conduct pre-renewal visits and review client loss experience and company performance
• Identify potential dissatisfaction before renewal meetings
• Perform client renewals, contract revisions, and Client Service Instruction preparation for complex programs
• Direct and influence internal departments to reduce process, technology, and resource constraints
• Coordinate client invoicing, audits, and accounts receivable follow-up
• Resolve major customer service issues
• Provide staff support, guidance, leadership, and motivation
• Administer personnel policies and follow staffing and training standards
• Interview, hire, and establish colleague performance development plans
• Conduct colleague performance discussions

Client Service Director – Claims Industry, Liability Experience Required

• Provide disability case management and complex claim determinations based on medical documentation and disability plan interpretation
• Determine benefits due and make timely payments, approvals, and adjustments for workers compensation, SSDI, and other disability offsets
• Review and analyze complex medical information to determine disability under the applicable plan
• Oversee complex claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines
• Utilize clinical resources in case assessment
• Inform claimants about required documentation, time frames, payment information, and claims status
• Communicate with claimants, clients, and providers regarding the claims process and return-to-work expectations
• Medically manage complex disability claims in compliance with duration control guidelines and plan provisions
• Coordinate investigations and thoroughly review contested claims
• Evaluate and arrange referrals to outside vendors, physician advisors, surveillance, independent medical evaluations, and functional capability evaluations
• Negotiate return to work with or without accommodations through the claimant’s physician and employer
• Refer cases for additional review when appropriate
• Maintain professional client relationships and provide excellent customer service
• Meet the organization’s quality program minimum requirements
• Perform other duties as assigned

• Analyze and process complex or technically difficult California workers' compensation claims
• 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 timely and appropriate reserves
• Manage reserve adequacy throughout the life of claims
• Calculate and pay benefits due
• Approve and make timely claim payments and adjustments
• Settle claims within designated authority level
• Prepare necessary state filings within statutory limits
• Manage litigation processes for timely and cost-effective claims resolution
• Report claims to the excess carrier
• Respond to requests for direction professionally and promptly
• Identify subrogation claims and negotiate settlements

Claims Examiner – Workers Compensation, CA Jurisdiction

• Analyze and process Workers Compensation 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
• Adjudicate complex workers compensation claims on behalf of clients
• Deliver customer-facing solutions to clients across industries
• Leverage Sedgwick’s global network of experts to learn and share insights

Workers Compensation Claims Examiner

Appraiser

• Inspect, identify, and evaluate auto vehicles involved in a loss
• Appraise and determine repair costs for damaged vehicles in the field
• Determine repair versus replace decisions and parts utilization
• Evaluate whether vehicles are repairable or salvageable using industry-standard estimatics software
• Travel to inspection locations to appraise vehicles in the field
• Prepare estimates using estimatics software
• Work directly with auto repair facilities on supplemental repair processing
• Provide supplemental estimates
• Perform other duties as assigned
• Travel as required

Field Auto Appraiser

• Inspect, identify, and evaluate auto vehicles involved in a loss
• Appraise and determine repair costs for damaged vehicles in the field
• Determine repair versus replace and parts utilization
• Evaluate whether vehicles are repairable or salvageable using industry standard estimatics software
• Travel to inspection locations to appraise vehicles in the field
• Prepare estimates using estimatics software
• Work directly with auto repair facilities on supplemental repair processing
• Provide supplemental estimates
• Perform other duties as assigned
• Travel as required

Events

• Provide excellent service and empathy to callers regarding claims across multiple lines of business
• Expedite the claims process and provide detailed claim notes on all calls
• Resolve issues with a one-call/one-person response and direct calls to appropriate escalation paths
• Act as primary liaison with callers from multiple client accounts in a shared services environment
• Assist with questions and solve problems related to claims applications and servicing processes
• Perform claim intake and full-service customer support within regulatory, company, and client requirements
• Educate customers about claim documentation, filing and processing time frames, payment information, and claim status
• Educate claimants and callers on client requirements and benefit plans
• Accurately enter verbal and written claim information into the appropriate system
• Direct customer calls to appropriate contacts or escalate to Service Center Specialists/management
• Perform other duties as assigned

Career Event – Meet, Interview, and Grow

Associate

• Process uncomplicated personal and commercial property claims within designated authority
• Ensure claim files are properly documented and coded according to policy
• Maintain action plans to meet state-required contact deadlines and move files toward prompt resolution
• Escalate issues as needed
• Identify and pursue subrogation opportunities
• Secure and dispose of salvage
• Communicate claim actions and processing with insureds, clients, agents, or brokers
• Perform other assigned duties
• Support organizational quality programs
• Travel as required

Claim Associate – Property

Administrative Assistant

• Provide administrative support, including preparing correspondence and reports, filing, and general office support
• Produce correspondence, reports, and other documentation in final form
• File documents and maintain and track suspense files
• Photocopy and send and receive facsimile transmissions
• Provide back-up telephone support
• Process invoices and billings; maintain records
• Maintain unit attendance records, libraries, and/or manuals
• Record meeting minutes
• Make travel arrangements
• Maintain adequate supply inventory and order supplies as needed
• Research a variety of topics as needed
• Perform other duties as assigned
• Support the organization's quality programs

Senior Administrative Assistant

General

• Analyze assigned claims and determine benefits due
• Inform claimants of documentation required to process claims and applicable timeframes
• Manage claims to ensure compliance with plan provisions
• Provide appropriate documentation to the LTD Manager for reporting purposes
• Determine the need for outside vendors, surveillance, and/or independent medical evaluations
• Seek management advice as necessary
• Refer cases to the LTD Supervisor, LTD Manager, or Project Manager
• Negotiate settlements of appropriate claims within designated authority level
• Make claim payments and revisions to benefit amounts
• Communicate decision status to clients, claimants, and supervisors
• Calculate and collect overpayments
• Perform other duties as assigned
• Support the organization's quality programs

Litigation Consultant – General Liability

Senior Disability Representative

Telephonic Case Manager

Claims Adjuster – Workers Compensation

Claims Examiner – Workers Compensation

Client Service Director – Claims Industry, Liability Experience Required

Senior Disability Representative

Claims Examiner – Workers Compensation, CA Jurisdiction

Workers Compensation Claims Examiner

Field Auto Appraiser

Field Auto Appraiser

Career Event – Meet, Interview, and Grow

Claim Associate – Property

Senior Administrative Assistant

Case Specialist