Claims Adjusters, Examiners, and Investigators

At **UnitedHealthcare** , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.**

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 3 to 5 weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

**Primary Responsibilities:**

+ Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjudicating Long Term Disability claims.

+ Communicating ongoing status and decisions both in writing and verbally

+ Authorizes the appropriate payment or refers claims to Team Lead or Manager for validation of adverse or over limit approvals

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ High School Diploma /GED OR equivalent work experience

+ Must be 18 years of age OR older

+ Presently Employed within UHC Consumer Operations

+ 1+ years of reviewing and rendering initial liability determinations on Long Term Disability claims

+ 1+ years of experience issuing monthly payments on Long Term Disability claims

+ Experience with Microsoft Word (ability to create, modify and send documents)

+ Experience with Microsoft Excel (ability to create, modify and send spreadsheets)

+ Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

**Telecommuting Requirements:**

+ Ability to keep all company sensitive documents secure (if applicable)

+ Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

+ Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $49,300 to $96,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

**_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._

_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._

_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._

_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

\#RPO

Specialist Claims - CH07DE

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

A new role can expand your knowledge and your network, and help you learn more about our business. If you think this opportunity is a fit for your career you should apply. If you are not sure you can have a conversation with your manager.

The Specialist role of Workers Compensation, Major Case unit will manage the investigation, litigation, disposition and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements. They will maintain, effectively create and communicate file strategies, and plans for achieving optimum claim outcomes and demonstrate advanced technical and jurisdictional expertise.

This role will be a part of a team of Major Case Unit Claim Specialists as well as a Home OfficeConsultant.

Timely and accurate reserving, Resolution and Settlement Strategies, Efficient, Timely and Accurate Investigations and Medical Management are responsibilities of this position. The position will also require strong written and verbal communication and presentation skills to ensure our internal and external customers are kept informed.

Responsibilities:

+ The MCU Claim Specialist will handle claims in the Western United States including CA, AZ, CO, NM, UT, NV

+ Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures to manage assigned claims

+ Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims

+ Maintain high standards and a clear understanding of goals for self

+ Maintain action-oriented, confident approach to work assignments

+ Use critical thinking skills to gather information, apply sound reasoning, draw appropriate conclusions and make sound decisions based on a mixture of analysis, experience and judgment

+ Stay current on issues impacting Workers’ Compensation including industry and marketplace trends, strategic direction of the organization, organizational structure and leadership, team goals and internal initiatives

+ Identify fraud indicators and initiate investigation on assigned claims

+ Demonstrate technical and jurisdictional expertise

+ Monitor financial results, trending and variances and identify, implement and manage appropriate adjustments

+ Communicate orally and in writing in a clear succinct manner

+ Possess superior analytical and critical thinking skills; expert knowledge of complex medical terms, excellent time management abilities

+ Properly apply statutory laws and regulations of applicable jurisdiction

Claim File Management and Technical Expertise:

+ Manage the completion and execution of the investigation, litigation, disposition and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements

+ Accurately and timely assess the indemnity, medical and expense exposure of assigned Specialized claims and manage the accurate and timely setting of reserves

+ Use organizational and communication skills to effectively manage the resolution of assigned claims, manage claim deadlines, and use resources appropriately

+ Use claim functional knowledge to appropriately interpret and apply insurance coverage;

+ Accurately resolve complex coverage and compensability issues

+ Demonstrate advanced expertise to use case management practices to effectively reduce loss costs.

+ Manage claims consistent with our Knowledge Management Tool, Claims Excellence Standards and Performance Improvement goals

Talent Management:

+ Effectively hold self-accountable for achievement of business results

+ Evaluate, acknowledge and manage individual performance through the use of appraisal tools

+ Effectively address and manage performance that does not meet required standards

+ Mentor and share jurisdictional and technical knowledge with peers, as needed, in order to build capabilities within the supported field claim offices

Customer Service:

+ Maintain dedication to meeting expectations and requirements of internal and external customers

+ Obtain first-hand customer information and use it for improvements in products and services

+ Establish and maintain effective relationships with customers, gaining their trust and respect

+ Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations

+ Negotiate skillfully in tough situations with internal and external groups

+ Set aggressive and realistic expectations for responding and follow through on commitment. Always demonstrate professionalism and establish credibility when interacting with customers

+ Personally enhance The Hartford’s reputation in the marketplace

+ Treat all customers with respect and careful attention

+ Clearly explain complex or technical information that is helpful to customers

Teamwork and Team Building:

+ Contribute to the building of appropriate rapport and constructive and effective relationships with people inside and outside the organization

+ Represent The Hartford as a credible, trustworthy, flexible and dependable resource; Demonstrate courtesy, honesty, integrity, respect and competence when interacting with others

+ Embrace role and offer advanced expertise to help teammates. solve problems, learn new skills and accomplish goals

+ Consistently act with the highest level of integrity and adhere to general principles of business ethics

Qualifications:

+ Minimum of 5+ years of P&C- Workers Compensation claim industry experience required

+ Strong technical understanding of Workers Compensation statutes and case law required

+ Jurisdictional knowledge and experience required (Western)

+ Ability to be coached, guided and mentored as you develop strategies on larger complex workers compensation claims

+ SCLA or CPCU designation preferred

+ Established ability to execute including a proven track record managing complex projects and initiatives

+ Strong analytical ability

+ Bias for action and continuous improvement

+ Effective communication, interpersonal and negotiation skills.

+ Ability to influence and communicate across multiple levels of the organization

+ Satisfactory completion of the candidate testing/certification process

+ Ability to use computer technology to efficiently perform job functions

+ Knowledge and experience using basic software program

+ Bachelor’s degree preferred

+ State required certification exams and adjusting licenses as jurisdiction requires

Additional Information:

+ This role can have a Hybrid or Remote work schedule. Candidates who live near one of our locations will have the expectation of working in an office 3 days a week (Tuesday through Thursday).

+ For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Mifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$106,400 - $159,600

Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Our Culture (https://www.thehartford.com/about-us/corporate-culture) | What It’s Like to Work Here (https://www.thehartford.com/careers/our-employees) | Perks & Benefits (https://www.thehartford.com/careers/benefits)

Every day, a day to do right.

Showing up for people isn’t just what we do. It’s who we are – and have been for more than 200 years. We’re devoted to finding innovative ways to serve our customers, communities and employees—continually asking ourselves what more we can do.

Is our policy language as simple and inclusive as it can be? Can we better help businesses navigate our ever-changing world? What else can we do to destigmatize mental health in the workplace? Can we make our communities more equitable?

That we can rise to the challenge of these questions is due in no small part to our company values that our employees have shaped and defined.

And while how we contribute looks different for each of us, it’s these values that drive all of us to do more and to do better every day.

About Us (https://www.thehartford.com/about-us)

Our Culture

What It’s Like to Work Here (https://www.thehartford.com/careers/our-employees)

Perks & Benefits (https://www.thehartford.com/careers/benefits)

Legal Notice (https://www.thehartford.com/legal-notice)

Accessibility StatementProducer Compensation (https://www.thehartford.com/producer-compensation)

EEO

Privacy Policy (https://www.thehartford.com/online-privacy-policy)

California Privacy Policy

Your California Privacy Choices (https://www.thehartford.com/data-privacy-opt-out-form)

International Privacy Policy

Canadian Privacy Policy (https://www.thehartford.com/canadian-privacy-policy)

Unincorporated Areas of LA County, CA (Applicant Information)

MA Applicant Notice (https://www.thehartford.com/ma-lie-detector)

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - Workers Compensation - Dedicated - Telecommute Virginia

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult workers' compensation 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.

+ 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

Virginia jurisdictional experience is required. Missouri and Wisconsin experience is a plus.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

\#LI-Remote

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values:

+ Clinical quality

+ Integrity

+ Service excellence

+ Teamwork

+ Accountability

+ Continuous improvement

+ Inclusion

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Click here (https://careers.sca.health/why-sca) to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will.

Responsibilities

+ Assures prompt, accurate credit balance research of patient accounts.

+ Processes refunds and initiates insurance check refunds requests in Accounts Payable system.

+ Sends overpayment letters series to carriers that have overpaid per contract.

+ Reviews and validates written requests received from insurances.

+ Submits payer disputes as needed.

+ Answers calls and inquiries from third-party carriers in reference overpayments or refunds requests.

+ Follows up on all outstanding credit accounts.

+ Calculate and verify expected pay based on contractual allowances for multiple payers.

+ Documents all work performed in patient accounting system.

+ Review of patient account history and notes to determine next step required for resolution per company guidelines.

+ Process contractual adjustment requests as needed to correct account balances.

+ Promptly processes all government refunds within timelines.

+ Runs monthly credit reports to verify that checks issued have been posted.

+ Performs all other duties as assigned by supervisor.

Qualifications

+ Excellent telephone skills & Customer Service Skills

+ High level of self-organization and tracking

+ Works independently, is a self-starter with a high level of initiative

+ Strong communication skills, both verbally and in writing

+ Possesses accurate judgement, especially handling insurance claims and dealing with patient accounts.

+ Versatile and willing to coordinate with and participate in, when necessary, all other aspects of the Business Office.

+ Ability to handle confidential information.

+ Possess basic knowledge of medical terminology.

+ Possess knowledge of health insurance billing.

+ Read and interpret EOBs and can calculate expected allowances based on payer contracts to determine reason for balance.

+ Possess knowledge of typing, word processing, spreadsheet and computer billing systems.

+ Must be dependable and reliable.

+ Ability to multi-task, think critically, and solve problems

+ One or more years’ experience in a related position working in a medical office, hospital, outpatient surgery center or related field with core duties related to medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements, or related training/certificates/diplomas

USD $19.00/Hr. USD $21.00/Hr.

**Who Are We?**

Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

**Job Category**

Claim

**Compensation Overview**

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

**Salary Range**

$129,200.00 - $213,200.00

**Target Openings**

1

**What Is the Opportunity?**

Investigate, evaluate, reserve, negotiate and resolve the company's most severe and/or complex claims, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, negotiating and resolution. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This may include a specific assignment as a severity management resource to one or more field offices.

**What Will You Do?**

+ CLAIM HANDLING:

+ Directly handle the Company's most severe and complex claims when Travelers has coverage of $2 million or greater and file exposure is greater than $2 million.

+ Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.

+ Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.

+ Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.

+ Complete outside investigation as needed per case specifics.

+ Actively engage in the identification, selection and direction of appropriate internal and./or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants and fire or fraud investigators and other experts.

+ Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.

+ Utilize diary management system to ensure that all claims are handled timely.

+ At required time intervals, evaluate liability & damages exposure.

+ Establish and maintain proper indemnity & expense reserves.

+ Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.

+ Apply the Company's claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.

+ Develop and employ creative resolution strategies.

+ Effectively and efficiently manage both allocated and unallocated loss adjustment expenses

+ Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.

+ Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives.

+ Ensure that the right resources are being applied to each claim to achieve the best result at the most optimal cost.

+ LEADERSHIP:

+ Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.

+ Field Severity Support: Some Complex Claim Specialists may be responsible for all or some of the following:

+ Collaborate with field severity units in the management and evaluation of some of the Company's severe and complex liability claims by providing claim handling guidance, recommendations and strategies to Field Product Line Managers, Unit Managers, and Major Case Specialists, for timely, cost effective resolution of liability major cases.

+ Provide mentoring or training as request by field severity management.

+ COMMUNICATION/INFLUENCE:

+ Consult with Manager on use of Claim Coverage Counsel as needed.

+ Provide guidance to underwriting business partners with res accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.

+ Recommend appropriate cases for discussion at roundtable.

+ Attend and or present at roundtables/authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.

+ Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.

+ Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws

+ Obtain and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.

+ Assist underwriting business partners in marketing and account-contact.

+ Actively participate in the coverage, liability and damages analysis and development of creative resolution strategy for severity cases handled in the field.

+ Assist in the recognition of available defenses to contain loss payout and setting of appropriate reserves.

+ Regularly and actively participate in field severity roundtables to share expertise and recommendations in all aspects of severe claim management.

+ Collaborate with the severity unit in compliance with company claim policies, procedures, practices and standards for the handling of cases that meet the Critical Claim referral guidelines.

+ OTHER ACCOUNTABILITIES:

+ Apply expert litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.

+ Recognize and implement alternate means of resolution.

+ Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.

+ Track and control legal expenses to assure cost-effective resolution.

+ Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.

+ Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.

+ Closely monitor independent counsel to ensure quality product.

+ Actively participate in periodic file quality reviews.

+ Appropriately deal with information that is considered personal and confidential.

+ Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers.

+ Perform other duties as assigned.

**What Will Our Ideal Candidate Have?**

+ College degree preferred or equivalent business experience.

+ 5-10 years experience handling serious injury and complex liability claims preferred (casualty claim operations environment determining coverage, liability, investigation, research, evaluation, negotiation and settlement).

+ Position requires a proficiency in oral and written communications.

+ Advanced communications skills are required to understand, interpret and convey highly technical information in simple terms to others.

+ Thorough understanding of product lines, objectives of claim management, and legal theory issues involving claim resolution. Familiarity with commercial lines/personal lines products, policy language, exclusions, ISO forms, effective claims handling practices.

+ Extensive experience handling large exposure and/or complex liability claims

+ Familiarity with commercial lines products, policy language, exclusions, ISO forms, effective claims handling practices.

+ Thorough understanding of the litigation process, relevant case and statutory law.

+ Ability to recognize, analyze and advise on complex coverage, liability and damage issues.

+ Expert written and verbal communication skills to understand, synthesize, interpret and convey complex data.

+ Create and manage positive working relationships with business and marketing partners.

+ Ability to analyze and effectively respond to human resource issues.

+ Utilize technology as a strategic tool.

+ Ability to make independent decisions up to $1,000,000 without involvement of supervisor.

+ Competencies:

+ Leading the Business - Drive Results.

+ Leads Change - Executes Business Strategy.

+ Leading Others - Attract Top Talent, Maximize Individual Performance, Holds Others Accountable, Aligns Rewards, Creates and Sustains a Dynamic Workplace.

+ Leading Self-Emotional Intelligence - Demonstrates Self-Awareness, Initiative and accountability, Applies Critical Thinking, Communications Effectively & Influences Others, Exhibits Courage, Conviction & Credibility.

**What is a Must Have?**

+ High School Degree or GED required.

+ 5 years bodily injury litigation claim handling experience or 10 years litigation experience required.

+ In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job.

**What Is in It for You?**

+ **Health Insurance** : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.

+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.

+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.

+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.

+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

**Employment Practices**

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (4-ESU@travelers.com) so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ .

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner Workers Comp I Remote I SE, Central, NE regions

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult workers' compensation 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.

+ 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_($_** **58,764 - $82,270** **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

California Workers Compensation Claims Examiner I Remote

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult workers' compensation 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.

+ 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($71,136 - $99,590_ **_)_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Job Description

We are a proud work-from-office company. If you're ready to work on-site in a dynamic, global company, we'd love to hear from you.

About Us

Vensure Employer Solutions is the largest privately held organization in the HR technology and service sector, providing a comprehensive portfolio of solutions, including HR/HCM technology, managed services, and global business process outsourcing (BPO). The company and its service providers collectively serve over 95,000 businesses and process over $135B in annual payroll. As a "One Employer Solution” headquartered in Chandler, Arizona, Vensure helps thousands of businesses streamline and grow their operations with custom strategies that benefit both employers and employees. Find out more by visiting www.vensure.com .

Position Summary

Workers' Compensation Claims Specialist will service clients worker's compensation claims with minimal supervision. This role requires that the Specialist monitor their assigned employers' workers' compensation claims, from inception thru closure, to ensure that all salient aspects of claim adjudication are being effectively and efficiently performed.

Essential Duties and Responsibilities

Responsible for servicing our Executive-level clients worker's compensation claims. Service includes shadow adjusting and acting as a liaison between the injured worker, client and TPA responsible for adjudicating workers' compensation losses. This involves ongoing detailed claims analysis, accident and subrogation investigation identifying red flags and potential fraud.
Additional responsibilities include ensuring accurate reserving practices, facilitating light duty, oversight and facilitation of both medical and legal management.
Ability to evaluate settlement value and coverage issues with the assistance of a Sr. Claims Specialist or Supervisor.
Mitigating claim severity and driving positive claim outcomes by leading our TPA towards claim resolution.
Preparing and presenting strategic claim reviews with client and/or carrier.

Knowledge, Skills, and Abilities

Team player with exceptional customer service skills.
High work standards, results orientation and self-motivated.
Strong complaints handling, dispute resolution and ability to manage difficult situations.
Ability to meet deadlines and ensure all tasks are completed within service guidelines.
Ability to make sound decisions with confidence.
Strong analytical skills with an eye for detail.
Ability to effectively coach and assist Claims Specialists and Claims Associates.

Education & Experience

High school/GED, some college preferred.
2-3 years of insurance or claims work experience required.

**Alternate Locations:** Work from Home; Charlotte, NC (North Carolina); Omaha, NE (Nebraska)

**Work Arrangement:**

Remote : Work at home employee

**Relocation assistance:** is not available for this opportunity.

**Requisition #:** 74754

**The Role at a Glance**

We are excited to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization.

As an LTD Claims Specialist, you will manage a workload of Long-Term Disability claims independently in accordance with established procedures and guidelines. You will be responsible for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You’ll complete a thorough training program to develop new skills and give you the confidence you need to be successful in your new role. If you enjoy working in a fast-paced team environment, then please read on!

**What you'll be doing**

• Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding Long Term Disability Claims and state and federal benefits when applicable.

• Collaborating with fellow case managers, nurse case managers, vocational case managers, and consulting physicians to make appropriate, ethical, and timely claim determinations.

• Reviewing complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning throughout the life of the claim.

• Providing exceptional customer service and proactively recognizing customer needs and areas of opportunity.

**What we’re looking for**

Must-haves:

• High School diploma or GED or minimum Associate degree in lieu of required experience.

• 3-5 years of claims experience directly aligned to the specific responsibilities for this role or;

For candidates with an Associate degree, 0-1 year claims experience directly aligned to the specific responsibilities for this role.

• Strong written and verbal communication skills.

• Excellent organization skills with the ability to multi-task.

Nice-to-haves:

Experience with disability and/or absence management.

**Application Deadline**

Applications will be accepted through July 11th, 2025, and the posting may be taken down earlier due to applicant volume.

**What’s it like to work here?**

At Lincoln Financial, we love what we do. We make meaningful contributions each and every day to empower our customers to take charge of their lives. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future.

**What’s in it for you:**

+ Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes

+ Leadership development and virtual training opportunities

+ PTO/parental leave

+ Competitive 401K and employee benefits (https://www.lincolnfinancial.com/public/aboutus/careers/lifeatlincoln#benefits)

+ Free financial counseling, health coaching and employee assistance program

+ Tuition assistance program

+ Work arrangements that work for you

+ Effective productivity/technology tools and training

The pay range for this position is $25.51 - $34.01 with **anticipated pay for new hires between the minimum and midpoint of the range** and could vary above and below the listed range as permitted by applicable law. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln’s total rewards package for employees. In addition, the role may be eligible for the Annual Incentive Program, which is discretionary and based on the performance of the company, business unit and individual. Other rewards may include long-term incentives, sales incentives and Lincoln’s standard benefits package.

**About The Company**

Lincoln Financial (NYSE: LNC) helps people to confidently plan for their version of a successful future. We focus on identifying a clear path to financial security, with products including annuities, life insurance, group protection, and retirement plan services.

With our 120-year track record of expertise and integrity, millions of customers trust our solutions and service to help put their goals in reach.

Lincoln Financial Distributors, a broker-dealer, is the wholesale distribution organization of Lincoln Financial. Lincoln Financial is the marketing name for Lincoln Financial Corporation and its affiliates including The Lincoln National Life Insurance Company, Fort Wayne, IN, and Lincoln Life & Annuity Company of New York, Syracuse, NY. Lincoln Financial affiliates, their distributors, and their respective employees, representatives and/or insurance agents do not provide tax, accounting or legal advice.

Lincoln is committed to creating an inclusive (https://www.lincolnfinancial.com/public/aboutus/companyoverview/ourvalues/diversityinclusion) environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Follow us on Facebook (https://www.facebook.com/lincolnfinancial/) , X (https://mobile.twitter.com/lincolnfingroup) , LinkedIn (https://www.linkedin.com/company/lincolnfinancial/) , Instagram (https://www.instagram.com/lincolnfinancial/) , and YouTube (https://www.youtube.com/@Lincoln\_Financial) . For the latest company news, visit our newsroom (https://www.lincolnfinancial.com/public/aboutus/newsroom) .

**Be Aware of Fraudulent Recruiting Activities**

If you are interested in a career at Lincoln, we encourage you to review our current openings and apply on our website. Lincoln values the privacy and security of every applicant and urges all applicants to diligently protect their sensitive personal information from scams targeting job seekers. These scams can take many forms including fake employment applications, bogus interviews and falsified offer letters.

Lincoln will not ask applicants to provide their social security numbers, date of birth, bank account information or other sensitive information in job applications. Additionally, our recruiters do not communicate with applicants through free e-mail accounts (Gmail, Yahoo, Hotmail) or conduct interviews utilizing video chat rooms. We will never ask applicants to provide payment during the hiring process or extend an offer without conducting a phone, live video or in-person interview. Please contact Lincoln's fraud team at fraudhotline@lfg.com if you encounter a recruiter or see a job opportunity that seems suspicious.

**Additional Information**

This position may be subject to Lincoln’s Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln’s current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities.

Any unsolicited resumes or candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial are considered property of Lincoln Financial and are not subject to payment of agency fees.

Lincoln Financial ("Lincoln" or "the Company") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex, age, national origin or disability. Opportunities throughout Lincoln are available to employees and applicants are evaluated on the basis of job qualifications. If you are a person with a disability that impedes your ability to express your interest for a position through our online application process, or require TTY/TDD assistance, contact us by calling 260-455-2558.

This Employer Participates in E-Verify. See the E-Verify (https://www.e-verify.gov) notices.

Este Empleador Participa en E-Verify. Ver el E-Verify (https://www.e-verify.gov/es) avisos.

Lincoln Financial Group ("LFG") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, veterans status, or genetic information. Opportunities throughout LFG are available to employees and applicants and are evaluated on the basis of job qualifications. We have a drug free work environment and we perform pre-employment substance abuse testing.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Sr. Claims Specialist, Medical Malpractice (LTC)

**PRIMARY PURPOSE** : To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyze and processes complex or technically difficult medical malpractice 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.

+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.

+ Negotiates claim settlement up to designated authority level.

+ Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.

+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.

+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.

+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.

+ Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.

+ Represents Company in depositions, mediations, and trial monitoring as needed.

+ Communicates claim activity and processing with 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.

+ Delegates work and mentors assigned staff.

**QUALIFICATION**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

**Experience**

Six (6) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products<

+ Analytical and interpretive skills

+ Strong organizational skills

+ Excellent negotiation skills

+ Good interpersonal skills

+ Ability to work in a team environmentAbility to meet or exceed Performance Competencies

+ When applicable and appropriate, consideration will be given to reasonable accommodations.

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

**WORK ENVIRONMENT**

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

**NOTE** **:** Credit security clearance, confirmed via a background credit check, is required for this position.

_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$100,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**