Qureos Mentor

Sedgwick

<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
Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions
<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 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? To analyze Lost-Time Workers Compensation ( litigated, subrogation, high exposure/severe cases) 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.
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
<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
<ul><li>Education &amp; Licensing: 2-3 years of claims management experience or equivalent combination of education and experience required.
</li><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>Jurisdiction Knowledge: NJ, PA, VA, DE
Licensing: DE preferred, not required
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></ul>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 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 (75,000 - 90,000). 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.
</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>

Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions

<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
Workers Compensation Claims Representative | Pasadena, CA
<div><div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
</div></div><div></div><div><div><div><div><div><div><div><div><div><ul><li>A stable and consistent work environment in an office setting
</li><li>A training program to learn how to help employees and customers from some of the world&rsquo;s most reputable brands
</li><li>An assigned mentor and manager who will guide you on your career journey
</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
</li></ul>PRIMARY PURPOSE OF THE ROLE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
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.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
</li><li>Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
</li><li>Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
</li><li>Administers subrogation of claims and negotiates settlements.
</li><li>Communicates claim action with claimant and client.
</li><li>Ensures claim files are properly documented and claims coding is correct.
</li><li>May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
</li><li>Maintains professional client relationships.
</li></ul>QUALIFICATIONS
Education &amp; Licensing: 2 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>TAKING CARE OF YOU
<ul><li>Entry-level colleagues are offered a world class training program with a comprehensive curriculum
</li><li>An assigned mentor and manager that will support and guide you on your career journey
</li><li>Career development and promotional growth opportunities
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more
</li></ul>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 $2600 - $28.00 per hour. 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></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>

Workers Compensation Claims Representative | Pasadena, 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
Claims Team Lead - Workers Compensation | Brea, 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><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
Brea, CA - Hybrid (3 days in office, 3 days remote)
PRIMARY PURPOSE OF THE ROLE: Oversees multiple teams of examiners and technical staff handling workers compensation claims for clients. Manages workloads, provides training, and monitors individual claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex or high-exposure case.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Supervises multiple teams of examiners and technical operations colleagues, delegating duties as needed and ensuring proper licensing and documentation standards.
</li><li>Provides technical and jurisdictional guidance on claims adjudication, including quality reviews and reserve evaluations for high-cost or complex claims.
</li><li>Acts as a second-level appeal authority for client and claimant issues, implementing final decisions.
</li><li>Identifies trends, issues, and opportunities for process improvement; advises management and coordinates related projects.
</li><li>Monitors third-party and sensitive claims, including litigated and vocational rehabilitation cases.
</li><li>Maintains professional client relationships, offering recommendations and written summaries as needed.
</li><li>Ensures accurate claim coding and documentation by examiners.
</li></ul>QUALIFICATIONS
Education &amp; Licensing: 6 years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
<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 claim handling experience | SIP Certified
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>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-$115,000/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.
#LI-GC1 #LI-Hybrid #claims #claimsteamlead
</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 Team Lead - Workers Compensation | 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
Claims Team Lead - Workers Compensation | Roseville or San Diego, CA
<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>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
 
Roseville, CA (Hybrid)
San Diego, CA (Hybrid)
</div>PRIMARY PURPOSE: To supervise the operation of workers compensation examiners 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.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Supervises a team of examiners; 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>QUALIFICATIONS
Education &amp; Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
Licensing / Jurisdiction Knowledge: California workers compensation claims handling experience | SIP Certified
TAKING CARE OF YOU
<ul><li>Flexible work schedule
</li><li>Career development
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one
</li></ul>As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000-$115,000/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.
#Claims #Supervisor #Hybrid #LI-Hybrid #LI-Remote #LI-AM
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 Team Lead - Workers Compensation | Roseville or San Diego, 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
Claims Team Lead - General Liability | Public Entity Exp. Required
<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?
<ul><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.
PRIMARY PURPOSE : To supervise the operation of a team of examiners 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
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Supervises a team 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>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</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>QUALIFICATIONS
Education &amp; Licensing
 
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
 
Six (6) years of General Liability claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
</div>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>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 $95,000 - $110,000. 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.
#Claims #ClaimsSupervisor #Hybrid #LI-Hybrid #LI-Remote #LI-AM1
</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 Team Lead - General Liability | Public Entity Exp. 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
RN Field Case Manager
<div>This Field Case Manager will cover our Chicago, IL region and must live in this area in order to be considered.
Must be an RN and have as least 1.5 years of prior Field Case Manager workers compensation experience.
PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers t o facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties. While frequent travel is required, you will maintain a home-based office.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
<ul><li>Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.
</li><li>Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment that allows face to face interaction with injured workers and medical professionals.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.
</li><li>Enable our Caring counts&reg; mission supporting injured employees from some of the world&rsquo;s best brands and organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process.
</li><li>Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation.
</li><li>Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source
</li></ul>EDUCATION AND LICENSING
RN licensure required. Valid driver&rsquo;s license required. High speed internet required.
TAKING CARE OF YOU BY
<ul><li>Offering a blended work environment.
</li><li>Supporting meaningful work that promotes critical thinking and problem solving.
</li><li>Providing on-going learning and professional growth opportunities.
</li><li>Promoting a strong team environment and a culture of support.
</li><li>Recognizing your successes and celebrating your achievements.
</li><li>We offer a diverse and comprehensive benefits package including:
<ul><li>Three Medical, and two dental plans to choose from.
</li><li>Tuition reimbursement eligible.
</li><li>401K plan that matches 50% on every $ you put in up to the first 6% you save.
</li>4 weeks PTO your first full year. 
<li>
</li></ul></li></ul>NEXT STEPS
If your application is selected to advance to the next round, a recruiter will be in touch.
#nurse #fieldcasemanager
</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>

RN Field Case Manager

<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
Litigation Consultant
<div><div>PRIMARY PURPOSE : To analyze complex or technically difficult third-party property liability claims and Uber no coverage bodily injury liability claims; to work with high exposure claims involving litigation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Analyzes and processes complex or technically difficult general liability 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.
</li><li>Assesses liability and resolves claims within evaluation.
</li><li>Negotiates settlement of claims within designated authority.
</li><li>Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
</li><li>Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
</li><li>Prepares necessary state fillings within statutory limits.
</li><li>Manages the litigation process; ensures timely and cost effective claims resolution.
</li><li>Coordinates vendor referrals for additional investigation and/or litigation management.
</li><li>Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
</li><li>Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
</li><li>Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
</li><li>Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
</li><li>Ensures claim files are properly documented and claims coding is correct.
</li><li>Refers cases as appropriate to supervisor and management.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li><li>Travels as required.
</li></ul>QUALIFICATION
Education &amp; Licensing
 
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
 
Five (5) years of claims management experience or equivalent combination of education and experience required.
Skills &amp; Knowledge
<ul><li>Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
</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>Excellent negotiation skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Service Expectations
</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
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 $75,000 to $80,000 . 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.
</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>

Litigation Consultant

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