Qureos Mentor

Sedgwick

Sedgwick is a leading provider of tech-enabled risk, benefits, and integrated business solutions, specializing in comprehensive claims management and loss adjusting across various industries. The company offers services such as claims administration, workers' compensation, and benefits administration, ensuring efficient resolution of claims with advanced technology and dedicated support. Sedgwick aims to make a meaningful impact through its services, helping clients navigate complex risk and claims scenarios.

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
ADA Accommodation Coordinator
Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:
Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002
Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401
Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241
Dublin, OH : 5500 Glendon Court Dublin OH 43016
Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268
Irving, TX : 2201 W. Royal Lane Suite 125 Irving, TX 75063
Memphis, TN : 8125 Sedgwick Way, Memphis TN 38125
Southfield, MI : 300 Galleria Officentre Southfield MI 48034
Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826
PRIMARY PURPOSE : To process claims and determine accommodation options following written guidelines and procedures pursuant to ADA, state and/or client requirements; to make timely referrals for appropriate disability and federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Informs claimants of documentation required to process claims, required time frames, and claims status either by phone, written correspondence and/or claims system.
</li><li>Reviews medical information to determine if the claimant meets the requirements under ADA, state, and/or client requirements for a qualifying condition.
</li><li>Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to deny claims based on the ADA, state, and/or client requirements. Processes ADA claims ensuring compliance with duration control guidelines, ADA and state regulations, and/or client-specific process provisions.
</li><li>Determines accommodation options; makes timely claims referrals for appropriate disability or federal/state leave of absence eligibility reviews where applicable.
</li><li>Conducts initial employee interview per process guidelines.
</li><li>Utilizes the appropriate clinical and vocational resources in case assessment (i.e. duration guidelines, in-house clinicians, ADA job accommodation specialists).
</li><li>Refers cases as appropriate to team lead.
</li><li>Maintains professional client relationships.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul>QUALIFICATIONS
Education &amp; Licensing
High school diploma or GED required.
Experience
Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of benefits or claims management experience preferred.
Skills &amp; Knowledge
<ul><li>Excellent oral and written communication skills
</li><li>PC literate, including Microsoft Office products
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Excellent interpersonal skills
</li><li>Good negotiation skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Performance Competencies
</li></ul>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.
<h2 class="jobSectionHeader">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.</h2></div>

ADA Accommodation Coordinator

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Examiner - Workers Compensation (HYBRID - Concord, CA)
<div><div>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&rsquo;s best brands?
</div><div><div><div><div><div><div><div><div><div><ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATIONS
 
Concord, CA
PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
</li><li>Negotiating settlement of claims within designated authority.
</li><li>Communicating claim activity and processing with the claimant and the client.
</li><li>Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
</li></ul>QUALIFICATIONS
Education &amp; Licensing: 5 years of claims management experience or equivalent combination of education and experience required.
<ul><li>High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
</li><li>Professional certification as applicable to line of business preferred.
</li></ul>Licensing / Jurisdiction Knowledge: California workers' compensation experience required | SIP Preferred
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul>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 $80,000 -$85,000/yr. 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.
#claimsexaminer #claims #hybrid
</div></div></div></div></div></div></div></div></div></div>Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles&rsquo; Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Examiner - Workers Compensation (HYBRID - Concord, CA)

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Complex Liability Adjuster
<h3 class="jobSectionHeader">Job Location : UAE
</h3><h3 class="jobSectionHeader">Job Type : Permanent
</h3><h3 class="jobSectionHeader">Remuneration: Competitive salary taking into account skills, experience and qualifications
</h3><h1 class="jobSectionHeader">Lead Complex Liability and Personal Injury Claims Across the Middle East with Our Global Specialty Team.
</h1>Join our Global Specialty team as a Complex Liability professional, supporting the delivery of complex liability and personal injury claims across the Middle East region. This highly visible role combines technical expertise, strategic client engagement, and leadership, working closely with insurers, brokers, legal professionals, and corporate clients on high-value and technically challenging matters.
You will bring at least 10 years of experience from a legal and/or insurance background, with strong knowledge of personal injury claims, liability protocols, and specialist areas such as Professional Indemnity, Product Liability, and Medical Malpractice. An LLB qualification is preferable, with ACII, ACILA, or equivalent professional qualifications highly desirable.
The role requires regular travel across the region for client meetings, site visits, and stakeholder engagement, making strong communication skills and commercial acumen essential. Previous Middle East experience and Arabic language skills would be advantageous but are not essential.
This is an outstanding opportunity to play a key role in the growth and success of a leading Global Specialty practice while working on some of the region's most complex and rewarding claims.
<h1 class="jobSectionHeader">The skills you will have when you apply:
</h1><ul><li>Senior-Level Expertise &ndash; Proven experience operating at Director, Associate Director, or equivalent senior leadership level within the insurance and/or legal sectors.
</li><li>Industry Background &ndash; Minimum 10 years&rsquo; experience within insurance, legal services, claims management, or a related field.
</li><li>Legal Qualification &ndash; LLB qualified, with a strong understanding of liability, litigation, and claims handling principles.
</li><li>Professional Accreditation &ndash; ACII, ACILA, or equivalent professional qualifications preferred.
</li><li>Personal Injury Knowledge &ndash; Extensive experience managing personal injury claims and applying relevant claims protocols.
</li><li>Specialist Claims Expertise &ndash; Strong technical knowledge of Complex Casualty, Professional Indemnity, Product Liability, Medical Malpractice, and related specialty risks.
</li><li>Stakeholder Management &ndash; Demonstrated ability to build trusted relationships with insurers, brokers, legal professionals, corporate clients, and other key stakeholders.
</li><li>Client-Facing Skills &ndash; Confident representing the business at client meetings, site visits, and industry engagements across the Middle East region.
</li><li>Technical Leadership &ndash; Ability to provide expert guidance, oversight, and strategic direction on complex and high-value claims.
</li><li>Commercial Acumen &ndash; Strong understanding of client needs, market dynamics, and business development opportunities within the specialty claims sector.
</li><li>Communication Skills &ndash; Excellent written and verbal communication skills in English, with the ability to influence and engage senior stakeholders.
</li><li>Regional Mobility &ndash; Willingness and ability to travel regularly throughout the Middle East to support clients and operational requirements.
</li><li>Middle East Experience (Desirable) &ndash; Previous experience working within Middle Eastern insurance, legal, or claims environments.
</li><li>A rabic Language Skills (Desirable) &ndash; Ability to communicate in Arabic would be advantageous but is not essential.
</li></ul><h1 class="jobSectionHeader">What we&rsquo;ll give you for this role:
</h1>Remuneration &amp; more
<ul><li>Competitive salary taking into account skills, experience and qualifications
</li><li>Gratuity
</li><li>Holiday allowance of 25 days plus bank holidays
</li><li>Flexible working from our office or your home
</li><li>Housing allowance
</li><li>Travel allowance
</li></ul>Health &amp; support
<ul><li>Private healthcare plan (including pre-existing conditions)
</li><li>Life assurance
</li><li>Employee assistance programme for employee wellbeing
</li><li>Group Income Protection
</li></ul>Other benefits
<ul><li>Voluntary benefits &ndash; dental cover, cycle to work scheme, season ticket loan, welling and digital GP applications
</li><li>Discounts on various products and services
</li></ul><h1 class="jobSectionHeader">This isn't just a position, it's a pivotal role in shaping our industry 
</h1>At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education. 
Together, we're not only reshaping the insurance landscape, we&rsquo;re building a legacy of talent. Come and be a catalyst for change within our industry. 
<h1 class="jobSectionHeader">Next steps for you:
</h1>Think we'd be a great match? Apply now &ndash; we want to hear from you. 
As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation. 
After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person).
#LI-HYBRID</div>

Complex Liability Adjuster

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Manager, Auto | Bodily Injury &amp; Property Damage
PRIMARY PURPOSE: To manage the technical and operational functions within assigned office(s) including compliance with company standards and industry best practices; to ensure consistent delivery of quality services; to be responsible for staffing and training needs; and to be responsible for budget preparation and profit and loss management. Has direct responsibility for 25-49 colleagues.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Responsible for overall operational management for assigned locations/offices.
</li><li>Establishes policy and procedure to assure compliance to best practices, claims management services standards, state regulations and client service requirements.
</li><li>Establishes business plan with goal and objectives for the partnership and assigned locations/offices.
</li><li>Monitors management reports relating to the partnership/office performance.
</li><li>Assists with the coordination of sales and client service efforts.
</li><li>Travels as required.
</li><li>Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
</li><li>Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
</li><li>Provides support, guidance, leadership and motivation to promote maximum performance.
</li></ul>QUALIFICATIONS
Education &amp; Licensing: Eight (8) years claims management experience including two (2) years supervisory experience or equivalent combination of experience and education.
<ul><li>Baccalaureate degree from an accredited college or university preferred. Licenses as required.
</li><li>Skills: excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, and leadership/management/motivational skills
</li></ul>Work environment requirements include &ndash;
 
Physical: Computer keyboarding
 
Auditory/visual: Hearing, vision and talking
 
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
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 $105,000 . 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.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Manager, Auto | Bodily Injury & Property Damage

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
National General Adjuster
PRIMARY PURPOSE : To handle losses or claims nationally regardless of size, including having the ability to address any complex adjustment issue and any medium sized and relatively complex National Account.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Examines insurance policies, claims, and other records to determine insurance coverage.
</li><li>Administers and reconciles complex catastrophic claims for property.
</li><li>Interviews, telephones, or corresponds with claimant(s) and witnesses regarding claim.
</li><li>Consults police and hospital records; and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance.
</li><li>Estimates cost of repair, replacement, or compensation.
</li><li>Prepares report of findings and negotiates settlement with claimant.
</li><li>Recommends litigation by legal department when settlement cannot be negotiated.
</li><li>Attends litigation hearings.
</li><li>Revises case reserves in assigned claims files to cover probably costs.
</li><li>Prepares loss experience reports to help determine profitability and calculates adequate future rates.
</li><li>Interacts with excess carrier to determine coverages, excess insurance levels, and potential reimbursements.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Travels as required.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
Bachelor's degree from an accredited college or university preferred. Must have earned the IIA-AIC designation and be actively pursuing another professional insurance designation.
Experience
 
Five (5) years of related experience or equivalent combination of education and experience required.
Skills &amp; Knowledge
<ul><li>Strong oral and written communication, including presentation skills
</li><li>PC literate, including Microsoft Office products
</li><li>Strong customer service skills
</li><li>Attention to detail and accuracy
</li><li>Good time management and organizational skills
</li><li>Ability to work independently or in a team environment
</li><li>Ability to meet or exceed Performance Competencies
</li></ul>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 :
<ul><li>Ability to stand and/or walk for long periods of time.
</li><li>Ability to kneel, squat or bend.
</li><li>Ability to work outdoors in hot and/or cold weather conditions.
</li><li>Ability to climb, crawl, stoop, kneel, reaching/working overhead.
</li><li>Ability to lift/carry up to 50 pounds.
</li><li>Ability to push/pull up to 100 pounds.
</li><li>Ability to drive up to 4 hours per day.
</li><li>Must have continual use of manual dexterity.
</li></ul>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.
<h2 class="jobSectionHeader">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.</h2></div>

National General Adjuster

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Representative (IAP) - Workers Compensation Training Program | Brea, CA
Are you looking for an impactful job that offers an opportunity to develop a professional career?
<ul><li>A stable and consistent work environment in an office setting.
</li><li>A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world&rsquo;s most reputable brands.
</li><li>Career development and promotional growth opportunities through increasing responsibilities.
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision &amp; 401k.
</li></ul>PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you&rsquo;ll have the opportunity to grow and advance within the industry. 
 
Next Class Date: August 31, 2026
Location: Brea, CA - Onsite 
 
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
<ul><li>Strong Communicators
</li><li>Empathetic
</li><li>Multi-Taskers
</li><li>Accountable
</li><li>Structured Thinkers
</li><li>Ambitious
</li><li>Agile Learners
</li><li>Team Collaborators
</li></ul>ESSENTIAL RESPONSIBLITIES INCLUDE
<ul><li>Attendance and completion of designated claims professional training program.
</li><li>Adjusting various levels of workers&rsquo; compensation claims under close supervision, which includes:
<ul><li>Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
</li><li>Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
</li><li>Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
</li><li>Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
</li><li>Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
</li><li>Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
</li><li>Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
</li></ul></li></ul>QUALIFICATIONS
Education Requirement &ndash; High School Diploma or GED.
Bachelor's degree preferred and 2 years of customer service experience and/or combination of education and experience. 
<ul><li>
</li></ul>WORK ENVIRONMENT REQUIREMENTS INCLUDE
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
Auditory/Visual: Hearing, vision and talking 
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 $27.69/hr. 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. #claims #entrylevel
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles&rsquo; Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Representative (IAP) - Workers Compensation Training Program | Brea, CA

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Disability Representative Sr
Our teams connect!
We collaborate onsite and have a hybrid work arrangement.
 
All candidates must live near one of our centers of excellence: 
Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401
 
Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241
 
Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002
 
Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604
 
Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826
 
Eden Prairie, MN : 11000 Prairie Lakes Drive Eden Prairie, MN 55344 
 
PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
</li><li>Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
</li><li>Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.
</li><li>Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.
</li><li>Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
</li><li>Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.
</li><li>Communicates with the claimants&rsquo; providers to set expectations regarding return to work.
</li><li>Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
</li><li>Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.
</li><li>Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
</li><li>Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
</li><li>Negotiates return to work with or without job accommodations via the claimant&rsquo;s physician and employer.
</li><li>Refers cases to team lead and clinical case management for additional review when appropriate.
</li><li>Maintains professional client relationships and provides excellent customer service.
</li><li>Meets the organization&rsquo;s quality program(s) minimum requirements.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
 
High School diploma or GED required. Bachelor's degree from an accredited university or college preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
Experience
 
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
Skills &amp; Knowledge
<ul><li>Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
</li><li>Knowledge of state and federal FMLA regulations
</li><li>Working knowledge of medical terminology and duration management
</li><li>Excellent oral and written communication, including presentation skills
</li><li>Proficient computer skills including working knowledge of Microsoft Office
</li><li>Analytical, interpretive, and critical thinking skills
</li><li>Ability to manage ambiguity
</li><li>Strong organizational and multitasking skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed performance competencies as required by program
</li><li>Effective decision-making and negotiation skills
</li><li>Ability to exercise judgement autonomously within established procedures
</li></ul>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 sit at a desk for extended periods while operating a computer and phone system. Travel as required.
Auditory/Visual : Hearing, vision and talking
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 $21.00 - $23.00. 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.
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.
<h2 class="jobSectionHeader">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.</h2></div>

Disability Representative Sr

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