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 focuses on delivering efficient claims administration, benefits management, and risk recovery services, ensuring clients receive timely support and innovative solutions tailored to their needs.

<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
Sr Account Consultant
PRIMARY PURPOSE : To manage claim caseload of highly complex claims, coverage issues (handling claims against insurance or other companies related to personal, casualty, or property loss of at least $1million) and complex litigation within granted authority level including related financial implications, along with financial implications and to mentor other team members. 
 
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Manages claim caseloads involving complex coverage issues with specific loss such as discontinuing business expense.
</li><li>Handles claims of at least one million dollars and that involve multiple buildings.
</li><li>Utilizes special account instructions to obtain individual customer information and adhere to instructions; identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
</li><li>Establishes and maintains effective relationship with internal and external customers and internal colleagues; communicates effectively and timely.
</li><li>Mentors and coaches account representatives and account specialists; facilitates round table discussions within the assigned team.
</li><li>Investigates, evaluates, and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations; interprets medical reports and state law or jurisdictional law in claim handling.
</li><li>Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
</li><li>Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
</li><li>Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve complex litigated claims.
</li><li>Ensures compliance and best possible outcomes by minimizing financial liability.
</li><li>Complies with all statutory guidelines and individual licensing requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines.
</li><li>Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team&rsquo;s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.
</li></ul>ADDITIONAL ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li>Supports the organization's quality program(s). 
<li>
</li></ul> 
QUALIFICATIONS
Education &amp; Licensing
 
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required. 
 
Experience
 
Eight (8) years of related experience or equivalent combination of experience and education required. 
 
Skills &amp; Knowledge
<ul><li>Thorough legal and jurisdictional knowledge based on line of business
</li><li>Strong oral and written communication, including presentation skills
</li><li>PC literate, including Microsoft Office products
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Strong Customer Service skills
</li><li>Excellent interpersonal 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>

Sr Account Consultant

<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 Team Lead | GL &amp; BI | Jurisdiction: MN | Licensing: MN - Remote
<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><ul><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li></ul></div><div></div><div>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.
</div></div><div><div>PRIMARY PURPOSE OF THE ROLE : To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims
</div><div>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</div><div><ul><li>Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
</li><li>Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
</li><li>Provides technical/jurisdictional direction to examiner reports on claims adjudication.
</li><li>Compiles reviews and analyzes management reports and takes appropriate action.
</li><li>Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
</li><li>Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
</li><li>Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
</li><li>Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
</li><li>Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
</li><li>Assures that direct reports are properly licensed in the jurisdictions serviced.
</li><li>Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
</li></ul>SUPERVISORY RESPONSIBILITIES
<ul><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></div><div>QUALIFICATIONS
</div><div>Education &amp; Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
</div><div>Experience : 6 years of claims management experience or equivalent combination of education and experience required. and experience required and two (2) years claims supervisor experience.
</div><div>Licensing / Jurisdiction Knowledge: MN
</div><div>TAKING CARE OF YOU
</div><div><ul><li>Flexible work schedule.
</li></ul></div><div><ul><li>Referral incentive program.
</li></ul></div><div><ul><li>Opportunity to work in an agile environment.
</li></ul></div><div><ul><li>Career development and promotional growth opportunities.
</li></ul></div><div>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 
<ul><li>
</li></ul></div><div>WORK ENVIRONMENT REQUIREMENTS INCLUDE
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
</div></div><div>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
</div><div>Physical: Computer keyboarding, travel as required
</div><div>Auditory/Visual : Hearing , vision and talking 
</div><div>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 ( 73,231.00 - 102,523.00 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.
</div><div># claimsexaminer #claims #hybrid #LI-REMOTE
</div>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 Team Lead | GL & BI | Jurisdiction: MN | Licensing: MN - Remote

<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, Auto
<div>PRIMARY PURPOSE OF THE ROLE: To analyze and process low to mid-level auto and transportation claims.
<div>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.
</li><li>Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.
</li><li>Identifies and pursues subrogation opportunities; secures and disposes of salvage.
</li><li>Communicates claim action/processing with insured, client, and agent or broker when appropriate.
</li><li>Maintains professional client relations.
</li><li>Performs coverage, liability, and damage analysis on all claims assignments.
</li><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul>QUALIFICATIONS
<ul><li>Education: Bachelor's degree from an accredited college or university preferred. Secure and maintain the State adjusting licenses as required for the position.
</li><li>Familiarity with personal and commercial lines policies and endorsements
</li><li>Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims.
</li><li>Knowledge of total loss processing, State salvage forms and title requirements, preferred
</li><li>Excellent oral and written communication, including presentation skills
</li><li>PC literate, including Microsoft Office products
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Good interpersonal skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Service Expectations
</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.
When applicable and appropriate, consideration will be given to reasonable accommodations.
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 $50,000 to $55,000. 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.
at any time.
</div></div>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, Auto

<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 I NY experience required
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?
<ul><li>Apply your workers compensation examiner 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>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.
ARE YOU AN IDEAL CANDIDATE? 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: New York License
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Opportunity to work in an agile environment.
</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 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 $60,234 - $90,000/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. Always accepting applications.
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 I NY experience required

<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 I NV experience required
<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?
<ul><li>Apply your workers compensation examiner 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>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.
ARE YOU AN IDEAL CANDIDATE? 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: Nevada License
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Opportunity to work in an agile environment.
</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 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 $60,234 - $90,000/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. Always accepting applications.
</div>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 I NV experience required

<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.
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
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 $23.00 USD hourly . 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.
<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.

Join Sedgwick and explore 31   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.