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Sedgwick Claims Management Services Inc.
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  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Service Center Representative | Shift Schedule: Monday-Friday 3pm -11pm with rotating Saturdays from 10am-6pm Shift Schedule: Monday-Friday 3pm-11pm with rotating Saturdays, 10am-6pm Location: In-Office, Blue Ash, OH PRIMARY PURPOSE: To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to resolve issues with one call/one person response; and to direct calls to appropriate escalation path as needed. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims application and servicing processes. * Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. * Educates claimants/callers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. * Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system. * Assigns new claims to the appropriate claims handler. * Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. * Attendance during scheduled work hours is required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. College courses preferred Experience One (1) year customer service experience or equivalent combination of education and experience required. Inbound call center experience preferred. Skills & Knowledge * Knowledge of medical terminology * Understanding of claims management * Excellent oral and written communication skills * PC literate, including Microsoft Office products * Strong organizational skills * Good interpersonal skills * Ability to multi task in fast paced environment * Ability to support multiple clients across communication channels and utilize multiple systems simultaneously * Ability to work in a team environment and/or independently * Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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 19.00. 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. Read Less
  • To provide excellent service to callers regarding claims for multiple... Read More
    To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to resolve issues with one call/one person response; and to direct call Representative, Shift, Claims, Service, Retail, Insurance Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Leave of Absence Coordinator Leave of Absence Coordinator Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you'll need to live near one of our dynamic Centers of Excellence Orlando, FL 12650 Ingenuity Dr, Orlando, FL 32826 What we offer: * A stable, consistent work environment-both in-office and virtual * $19.31 per hour * A comprehensive training program to help you support employees and customers from some of the world's most respected brands * A dedicated mentor and manager to guide you every step of your career journey * Career development and promotional opportunities as you take on new responsibilities * A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being Your next big opportunity starts here-are you ready to join us? PRIMARY PURPOSE: Analyzes reported leave requests including Family Medical Leave (FMLA), unpaid state, military and company-specific, to make determinations based on client plans, state and federal regulations. Ensures that on-going claim management is within company service standards and industry best practices. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Establishes FMLA and other unpaid state, military, and/or company-specific leave claims; tracks and codes documentation in accordance with internal workflow processes. * Analyzes FMLA and other unpaid claims to determine eligibility and certification in compliance with client plans, state and federal regulations. * Reviews claim information received to identify action plan, determine benefits due, and make timely case decisions based on plan descriptions and service expectations as established by the client. * Communicates decisions and on-going expectations clearly and professionally with claimants and clients by phone, written correspondence and/or claims system. * Maintains professional client relationships and provides excellent customer service. * Meets the organization's quality program(s) minimum requirements. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. QUALIFICATIONS Education & Licensing High school diploma or GED required. State certification or licensing in statutory leaves is beneficial. Experience One (1) year of administrative/general office experience or equivalent combination of education and experience required. FMLA administration experience preferred. Skills & Knowledge * Knowledge of state and federal FMLA regulations * Excellent oral and written communication, including presentation skills * Proficient computer skills including working knowledge of Microsoft Office * Analytical and interpretive skills * Strong organizational and multitasking skills * Excellent interpersonal skills * Ability to exercise judgement in accordance with well-defined policies and procedures * Ability to work in a team environment * Ability to meet or exceed performance competencies as required by program WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Ability to sit at a desk for extended periods while operating a computer and phone system. 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 19.31. 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. Read Less
  • Regional Manager  

    - New York City
    By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Regional Manager PRIMARY PURPOSE: To create profitable growth by acquiring and maintaining new and existing client relationships and increasing market presence by utilizing superior, innovative and personalized service. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Develops and implements annual business plans and delivers profitable growth of the business' operating revenues and earnings budget utilizing Sedgwick's business processes. * Generates and establishes talent, management, and financial control plans to secure successful execution of a regions performance. * Oversees activities of assigned property and casualty staff to ensure efficient operation of branch. * Facilitates communication between internal and external customers. * Monitors work product for validity and accuracy to ensure it is delivered technically and grammatically correct to the intended audience. * Creates and maintains an environment of customer and colleague satisfaction. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). * Travels as required. SUPERVISORY RESPONSIBILITIES * Administers company personnel policies in all areas and follows company staffing standards and training recommendations. * Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. * Provides support, guidance, leadership and motivation to promote maximum performance. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience Eight (8) years of related experience or equivalent combination of education and experience, including but not limited to technical multi-lines insurance claims adjusting and people leadership experience. Skills & Knowledge * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Leadership/management/motivational skills * Analytical and interpretive skills * Strong organizational skills * Excellent interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Performance Competencies 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: * Ability to stand and/or walk for long periods of time * Ability to kneel, squat or bend * Ability to work outdoors in hot and/or cold weather conditions. * Ability to climb, crawl, stoop, kneel, reaching/working overhead * Ability to lift/carry up to 50 pounds and to push/pull up to 100 pounds * Ability to drive up to 4 hours per day * Must have continual use of manual dexterity 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 $96k-$122k bonus eligible. 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. We are always accepting applications. 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. Read Less
  • Regional Manager  

    - New York City
    To create profitable growth by acquiring and maintaining new and exist... Read More
    To create profitable growth by acquiring and maintaining new and existing client relationships and increasing market presence by utilizing superior, innovative and personalized service. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Develops and implemen Regional Manager, Manager, Skills, Insurance, Business Services, Performance Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Care Team Representative Entry-level, Care Team Representative Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you'll need to live near one of our dynamic Centers of Excellence Irving, TX: 2201 W. Royal Lane, Suite 125, Irving TX 75063 What we offer: * A stable, consistent work environment-both in-office and virtual * A comprehensive training program to help you support employees and customers from some of the world's most respected brands * A dedicated mentor and manager to guide you every step of your career journey * Career development and promotional opportunities as you take on new responsibilities * A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being Your next big opportunity starts here-are you ready to join us? See what a day in the life of a Care Team Representative is like: SED23026 - Mariah_01-09-24 (vidyard.com) &https://share.vidyard.com/watch/VCLjdFEUwPccjWaBtjLmwX Learn more about our Care Team: Care Team (ceros.com) PRIMARY PURPOSE: To provide excellent service displaying empathy to callers regarding claims for multiple lines of business, including but not limited to, expediting the claims process and providing detailed claim notes on all calls, resolving issues with one call/one person response, and directing calls to appropriate escalation path as needed. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Acts as primary liaison with callers from multiple client accounts within a shared services environment. * Follows specifications in assisting with questions and solving problems related to the claims application and servicing processes. * Performs claim intake and full-service customer support within regulatory requirements, company, and client expectations at all times. * Educates and informs the customer about documentation required to file/process a claim, required time frames, payment information, and claim status. * Educates claimants/callers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. * Enters verbal and written claim information that meets both the internal and external customer's requirements accurately into the appropriate system. * Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. * Attendance during scheduled work hours is required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience One (1) year customer service experience or equivalent combination of education and experience required. Inbound call center experience preferred. Skills & Knowledge * Excellent verbal and written communication skills * PC literate, including Microsoft Office products, Windows environment * Must meet minimum typing requirements * Strong organizational skills * Good interpersonal skills * Ability to multi task in fast paced environment * Ability to support multiple clients across communication channels and utilize multiple systems simultaneously * Ability to work in a team environment and/or independently * Ability to meet or exceed Performance Competencies * Ability to meet all attendance expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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 (16.00 - 17.85). 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. #entrylevel #contactcenterrep 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. Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Accounts Payable Specialist HYBRID schedule Monday - Friday 9AM - 6PM PRIMARY PURPOSE: To administer banking services for clients and local offices; to confirm check clearances and make stop payments; to enter voids into the claims management system; and to provide cleared check copies when requested. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Issues stop payments using bank software. * Enters voids into claims management system. * Completes bank deposit tickets, endorses checks, and mails to bank. * Makes copies of checks for deposit and attaches to appropriate form. * Confirms check clearances with bank for local offices. * Provides check copies to clients and local offices. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience One (1) year experience in accounting or related field or equivalent combination of education and experience required. Skills & Knowledge * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Strong organizational skills * Excellent interpersonal skills * Ability to work in a team environment * Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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. 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. Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Operation Manager PRIMARY PURPOSE: To oversee technical and operational functions including compliance with company standards and industry best practices; to ensure consistent delivery of quality services; to oversee staffing and training needs; and to oversee budget preparation and profit and loss management. Has direct responsibility for less than 25 colleagues. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Oversees internal quality review process and reports monthly. * Assures compliance with client internal controls, audit requirements and service agreement requirements. * Establishes business plan with goals and objectives for assigned clients. * Ensures claims management policies and procedures are followed to assure meeting service standards, state statutes/regulations, disability plan document, industry best practices and client service requirements. * Establishes and maintains client contacts. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). * Travels as required. SUPERVISORY RESPONSIBILITIES * Administers company personnel policies in all areas and follows company staffing standards and training recommendations. * Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. * Provides support, guidance, leadership and motivation to promote maximum performance. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications appropriate to line of business preferred. Experience Eight (8) years claims management experience or equivalent combination of education and experience required to include two (2) years supervisory experience. Skills & Knowledge * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Leadership/management/motivational skills * Analytical and interpretive skills * Strong organizational skills * Excellent interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Performance Competencies 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 $78,462.00 - 100,000.00 USD Annual. 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. Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 Service Center Representative - Bartlesville, OK ON-SITE Ready to make an impact? Join us at one of our vibrant Centers of Excellence! Location: Bartlesville, OK - 117 W 5th St., 3rd Floor (corner of 5th and Keeler) Why you'll love being part of our team: * Join a respected, rapidly growing insurance organization * Make a real difference by guiding people through life's most important moments * Build your expertise in insurance operations and customer service * Thrive in a supportive, team-focused environment with clear paths for growth and advancement If you're ready to bring empathy, efficiency, and expertise to every interaction, we can't wait to welcome you aboard! PRIMARY PURPOSE: Step into a vital role at the heart of the insurance claims process. As a Customer Experience Specialist, you'll be the first point of contact for policyholders during some of their most important moments. Your mission is to provide clear, compassionate, and knowledgeable support-ensuring every caller feels heard, informed, and confident in the process. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims application and servicing processes. * Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. * Educates claimants/callers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. * Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system. * Assigns new claims to the appropriate claims handler. * Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. * Attendance during scheduled work hours is required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. College courses preferred Experience At least one year of customer service experience (insurance or call center experience preferred) Skills & Knowledge * Knowledge of medical terminology * Understanding of claims management * Strong communication skills with the ability to explain complex information clearly * Proficiency with Microsoft Office and the ability to navigate multiple systems simultaneously * Strong organizational skills * Familiarity with insurance terminology and claims processes * Strong organizational skills and the ability to multitask in a fast-paced environment * Ability to support multiple clients across communication channels and utilize multiple systems simultaneously * A collaborative mindset with the ability to work independently when needed * Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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. 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. Read Less
  • By joining Sedgwick, you'll be part of something truly meaningful. It'... Read More
    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 | Jurisdiction: WA | Licensing: Preferred Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. ARE YOU AN IDEAL CANDIDATE? 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. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. ESSENTIAL RESPONSIBLITIES MAY INCLUDE * 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. * Performs other duties as assigned. * Supports the organization's quality program(s). * Travels as required. QUALIFICATIONS Education and 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. Jurisdiction Knowledge: WA Licensing: WA TAKING CARE OF YOU Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 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. 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. Read Less

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