Claims Adjusters, Examiners, and Investigators

**Optum** is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**

Imagine this. Every day, in claims centers around the world, UnitedHealth Group is processing and resolving payment information for millions of transactions. Would you think we have some great technology? Would you think we know how to manage volume? You would be right. No one’s better. And no company has put together better teams of passionate, energetic and all out brilliant Claims Representative Associates. This is where you come in. We’ll look to you to maintain our reputation for service, accuracy and a positive claims experience. We’ll back you with great training, support and opportunities.

This position is full time. Employees are required to have flexibility to work our normal business hours of 8:00am-4:30pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 10 - 12 weeks of paid training. The hours during training will be 7:30am-4:00pm CST. Training will be conducted virtually from your home.

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

**Primary Responsibilities:**

+ Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims

+ Analyze and identify trends and provide reports as necessary

+ Consistently meet established productivity, schedule adherence and quality standards

+ This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy, which will impact the timely processing of the member's claim.

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

**Required Qualifications:**

+ High School Diploma / GED OR equivalent years of work experience

+ Must be 18 years of age OR older

+ Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications

+ Ability to work full time. Employees are required to have flexibility to work our normal business hours of 8:00am-4:30pm CST. It may be necessary, given the business need, to work occasional overtime.

**Preferred Qualifications:**

+ 1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.), using phones and computers as primary job tools

+ 1+ years of experience with processing medical, dental, prescription, OR mental health claims

**Telecommuting Requirements:**

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

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

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

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

The hourly range for this role is $16.00 to $28.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

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

_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._

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

\#RPO

Description

We are seeking a detail-oriented OSP (Outside Plant) Field Inspector to join our team on a contract basis. The ideal candidate will be responsible for conducting thorough inspections of Fiber Optic infrastructure, ensuring compliance with industry standards and safety regulations.

Skills

Telecommunication, Fiber optic, Osp, Telecommunications construction, Underground cable, Construction, Inspection, Fiber optic cable, Blueprint, Repair

Top Skills Details

Telecommunication, Fiber optic, Osp, Telecommunications construction, Underground cable, Construction, Inspection, Fiber optic cable

Additional Skills & Qualifications

Responsibilities and Duties

• Inspecting and assessing the condition of outside plant fiber optic facilities,

• Documenting findings and preparing detailed reports on infrastructure quality and compliance issues.

• Collaborating with project managers and engineers to address any discrepancies or corrective actions needed.

• Conducting site visits and audits to verify construction quality and adherence to specifications.

• Collaborate with General Contractors, setting expectations, provide feedback/guidance, and ensure work is being performed to company standards.

• Ability to build and maintain effective working relationships across multiple diverse stakeholders (team, leadership, internal partners, vendors, local governments agencies, and customers, etc.).

• Communicate regularly with management regarding problems or issues impacting production.

• Exceptional work ethic. Must be able to work nights and weekends, variable schedule(s), and extended hours, as necessary.

• Supports with customer escalations resulting from the construction process including damage claim repairs and customer communication.

• Other duties as assigned.

Experience Level

Intermediate Level

Pay and Benefits

The pay range for this position is $25.00 - $29.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Phoenix,AZ.

Application Deadline

This position will be accepting applications until Jan 22, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Description

We are seeking a detail-oriented OSP (Outside Plant) Field Inspector to join our team on a contract basis. The ideal candidate will be responsible for conducting thorough inspections of Fiber Optic infrastructure, ensuring compliance with industry standards and safety regulations.

Skills

Telecommunication, Fiber optic, Osp, Telecommunications construction, Underground cable, Construction, Inspection, Fiber optic cable, Blueprint, Repair

Top Skills Details

Telecommunication,Fiber optic,Osp,Telecommunications construction,Underground cable,Construction,Inspection,Fiber optic cable

Additional Skills & Qualifications

Responsibilities and Duties

• Inspecting and assessing the condition of outside plant fiber optic facilities,

• Documenting findings and preparing detailed reports on infrastructure quality and compliance issues.

• Collaborating with project managers and engineers to address any discrepancies or corrective actions needed.

• Conducting site visits and audits to verify construction quality and adherence to specifications.

• Collaborate with General Contractors, setting expectations, provide feedback/guidance, and ensure work is being performed to Prime Fiber standards.

• Ability to build and maintain effective working relationships across multiple diverse stakeholders (team, leadership, internal partners, vendors, local governments agencies, and customers, etc.).

• Communicate regularly with management regarding problems or issues impacting production.

• Exceptional work ethic. Must be able to work nights and weekends, variable schedule(s), and extended hours, as necessary.

• Supports with customer escalations resulting from the construction process including damage claim repairs and customer communication.

• Other duties as assigned.

Experience Level

Intermediate Level

Pay and Benefits

The pay range for this position is $25.00 - $29.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Phoenix,AZ.

Application Deadline

This position will be accepting applications until Jan 29, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Description



We are seeking a detail-oriented OSP (Outside Plant) Field Inspector to join our team on a contract basis. The ideal candidate will be responsible for conducting thorough inspections of Fiber Optic infrastructure, ensuring compliance with industry standards and safety regulations.

Skills

Telecommunication, Fiber optic, Osp, Telecommunications construction, Underground cable, Construction, Inspection, Fiber optic cable, Blueprint, Repair

Top Skills Details

Telecommunication, Fiber optic ,Osp, Telecommunications construction, Underground cable ,Construction ,Inspection, Fiber optic cable

Additional Skills & Qualifications

+ Inspecting and assessing the condition of outside plant fiber optic facilities,

+ Documenting findings and preparing detailed reports on infrastructure quality and compliance issues.

+ Collaborating with project managers and engineers to address any discrepancies or corrective actions needed.

+ Conducting site visits and audits to verify construction quality and adherence to specifications.

+ Collaborate with General Contractors, setting expectations, provide feedback/guidance, and ensure work is being performed to Prime Fiber standards.

+ Ability to build and maintain effective working relationships across multiple diverse stakeholders (team, leadership, internal partners, vendors, local governments agencies, and customers, etc.).

+ Communicate regularly with management regarding problems or issues impacting production.

+ Exceptional work ethic. Must be able to work nights and weekends, variable schedule(s), and extended hours, as necessary.

+ Supports with customer escalations resulting from the construction process including damage claim repairs and customer communication.

+ Other duties as assigned.

Pay and Benefits

The pay range for this position is $25.00 - $29.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Phoenix,AZ.

Application Deadline

This position will be accepting applications until Jan 29, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Description

We are seeking a detail-oriented OSP (Outside Plant) Field Inspector to join our team on a contract basis. The ideal candidate will be responsible for conducting thorough inspections of Fiber Optic infrastructure, ensuring compliance with industry standards and safety regulations.

Skills

Telecommunication, Fiber optic, Osp, Telecommunications construction, Underground cable, Construction, Inspection, Fiber optic cable, Blueprint, Repair

Top Skills Details

Telecommunication,Fiber optic,Osp,Telecommunications construction,Underground cable,Construction,Inspection,Fiber optic cable

Additional Skills & Qualifications

Responsibilities and Duties

• Inspecting and assessing the condition of outside plant fiber optic facilities,

• Documenting findings and preparing detailed reports on infrastructure quality and compliance issues.

• Collaborating with project managers and engineers to address any discrepancies or corrective actions needed.

• Conducting site visits and audits to verify construction quality and adherence to specifications.

• Collaborate with General Contractors, setting expectations, provide feedback/guidance, and ensure work is being performed to Prime Fiber standards.

• Ability to build and maintain effective working relationships across multiple diverse stakeholders (team, leadership, internal partners, vendors, local governments agencies, and customers, etc.).

• Communicate regularly with management regarding problems or issues impacting production.

• Exceptional work ethic. Must be able to work nights and weekends, variable schedule(s), and extended hours, as necessary.

• Supports with customer escalations resulting from the construction process including damage claim repairs and customer communication.

• Other duties as assigned.

Experience Level

Intermediate Level

Pay and Benefits

The pay range for this position is $25.00 - $29.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Phoenix,AZ.

Application Deadline

This position will be accepting applications until Jan 29, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

**40479BR**

**Requisition ID:**

40479BR

**Business Unit:**

FSU

**Job Description:**

The FEMA Insurance Specialist:

• Inspects damaged property to include all parts of the structure, taking into consideration condition, design, construction, and land value.

• Photographs interior and exterior components and all areas of the property to document findings. Verifies legal descriptions in public records and uses comparable methods to determine value.

• Prepares detailed appraisal reports. Communicates and coordinates with staff within FEMA as well as local, state, tribal and/or territorial governments.

• May coordinate and complete basic to moderately complex site inspections to validate and record damage to assist in the FEMA Public Assistance grant delivery process.

• Performs other duties as assigned.

\#LI-LP2

**Job Title:**

FEMA - Insurance Specialist

**Group:**

WAF Field Mod Fringe

**Employment Type:**

Temporary

**Minimum Qualifications:**

• HS Diploma or equivalent.

• 5 years of in-field experience or 2 years of in-field of expertise with a bachelor’s degree.

Domestic travel is required.

**EEO Statement:**

We attract the best people in the industry, supporting their efforts to learn and grow. We strive to create a challenging and progressive work environment. We provide career opportunities that span a variety of disciplines and geographic locations, with projects that our employees plan, design, build and operate as diverse as the needs of our clients. CDM Smith is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, pregnancy related conditions, childbirth and related medical conditions, sexual orientation, gender identity or gender expression), national origin, age, marital status, disability, veteran status, citizenship status, genetic information or any other characteristic protected by applicable law.

**Why CDM Smith?:**

Check out this video and find out why our team loves to work here! (https://www.cdmsmith.com/en/Video/Meet-CDM-Smith)

**Join Us! CDM Smith – where amazing career journeys unfold.**

Imagine a place committed to offering an unmatched employee experience. Where you work on projects that are meaningful to you. Where you play an active part in shaping your career journey. Where your co-workers are invested in you and your success. Where you are encouraged and supported to do your very best and given the tools and resources to do so. Where it’s a priority that the company takes good care of you and your family.

Our employees are the heart of our company. As an employer of choice, our goal is to provide a challenging, progressive and inclusive work environment which fosters personal leadership, career growth and development for every employee. We value passionate individuals who challenge the norm, deliver world-class solutions and bring diverse perspectives. Join our team, and together we will make a difference and change the world.

**Job Site Location:**

United States - Nationwide

**Agency Disclaimer:**

All vendors must have a signed CDM Smith Placement Agreement from the CDM Smith Recruitment Center Manager to receive payment for your placement. Verbal or written commitments from any other member of the CDM Smith staff will not be considered binding terms. All unsolicited resumes sent to CDM Smith and any resume submitted to any employee outside of CDM Smith Recruiting Center Team (RCT) will be considered property of CDM Smith. CDM Smith will not be held liable to pay a placement fee.

**Amount of Travel Required:**

100%

**Assignment Category:**

Fulltime-Temporary

**Visa Sponsorship Available:**

No - We will not support sponsorship, i.e. H-1B or TN Visas for this position

**Skills and Abilities:**

• Must be a U.S. citizen and be able to obtain a FEMA Badge, which includes a background investigation for a Public Trust position.

• High competency with the use of computers and computing software (Word, Excel).

• Demonstrates good organizational skills to balance and prioritize work.

• Demonstrates strong attention to detail and ability to work independently.

• Good written and oral communication skills.

• Ability to work with multiple stakeholders and process a large volume of requests.

• Ability to adapt to change quickly and remain flexible.

**Background Check and Drug Testing Information:**

CDM Smith Inc. and its divisions and subsidiaries (hereafter collectively referred to as “CDM Smith”) reserves the right to require background checks including criminal, employment, education, licensure, etc. as well as credit and motor vehicle when applicable for certain positions. In addition, CDM Smith may conduct drug testing for designated positions. Background checks are conducted after an offer of employment has been made in the United States. The timing of when background checks will be conducted on candidates for positions outside the United States will vary based on country statutory law but in no case, will the background check precede an interview. CDM Smith will conduct interviews of qualified individuals prior to requesting a criminal background check, and no job application submitted prior to such interview shall inquire into an applicant's criminal history. If this position is subject to a background check for any convictions related to its responsibilities and requirements, employment will be contingent upon successful completion of a background investigation including criminal history. Criminal history will not automatically disqualify a candidate. In addition, during employment individuals may be required by CDM Smith or a CDM Smith client to successfully complete additional background checks, including motor vehicle record as well as drug testing.

**Pay Range Minimum:**

$33.60

**Pay Range Maximum:**

$67.20

**Additional Compensation:**

All bonuses at CDM Smith are discretionary and may or may not apply to this position.

**Work Location Options:**

Successful candidate will be required to work in office and field locations as needed.

**Driver's License Requirements:**

An appropriate and valid driver's license is required.

**Seeking candidates for a potential future opportunity!:**

We are excited to announce that CDM Smith won the next 5-year contract for Public Assistance Technical Assistance Contractors – PA TAC V in the West Zone. The West Zone includes Alaska, Washington, Oregon, Idaho, Nevada, California, Arizona, Northern Mariana Islands, American Samoa, Guam, Hawaii, Nebraska, Iowa, Kansas and Missouri. We are looking for qualified candidates for this position in anticipation of future project opportunities. Please note this is an “Evergreen” position which will be used to build our candidate pool but is not a role that is open at this time. If you are interested in being considered for this position should this position become available, we encourage you to apply to be part of our talent community. By having your information on file, we can reach out to you when this or a similar role officially opens.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Adjuster - Workers Compensation (REMOTE)

**PRIMARY PURPOSE** **:** To analyze mid- and higher-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.

Florida experience preferred.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

+ Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.

+ Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

+ Manages subrogation of claims and negotiates settlements.

+ Communicates claim action with claimant and client.

+ Ensures claim files are properly documented and claims coding is correct.

+ May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

+ Maintains professional client relationships.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATIONS**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred.

**Experience**

Four (4) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skill

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

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

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

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

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Adjuster - Liability - Cerritos, California - We require adjusters with both litigation and public entity experience

**PRIMARY PURPOSE** :

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

**_· Support our public entity liability desks in Cerritos, CA_**

**_· These positions focus on public entity claims involving Auto Liability (AL), General Liability (GL), Employment Practices Liability (EPL), and Childhood Sexual Assault cases_**

**_· We require adjusters with both litigation and public entity experience._**

**_· Very high Volume_**

**_· Call center environment_**

**_· Cradle to grave claim handling_**

**_**** During high volume account may be 6-7 days per week 10 hour days. This is fluid based on client need****_**

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ 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.

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

+ Prepares necessary state fillings within statutory limits.

+ Manages the litigation process; ensures timely and cost effective claims resolution.

+ Coordinates vendor referrals for additional investigation and/or litigation management.

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

+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

+ Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

+ Ensures claim files are properly documented and claims coding is correct.

+ Refers cases as appropriate to supervisor and management.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

**_3+ Years with public entity and litigation experience – auto liability (AL), general liability (GL), employment practices liability (EPL), and childhood sexual assault case experience._**

**Skills & Knowledge**

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

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

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

_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $33-$36/hr_ _. Eligible for 401K._ **_Always accepting applications_** _._

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

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

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Adjuster - Workers Compensation (REMOTE)

**PRIMARY PURPOSE** **:** To analyze mid- and higher-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.

Florida experience preferred.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

+ Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.

+ Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

+ Manages subrogation of claims and negotiates settlements.

+ Communicates claim action with claimant and client.

+ Ensures claim files are properly documented and claims coding is correct.

+ May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

+ Maintains professional client relationships.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATIONS**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred.

**Experience**

Four (4) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skill

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

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

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

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

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Adjuster

**PRIMARY PURPOSE** **:** To analyze mid- and higher-level general auto claims to determine scope of damages; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.

+ Assesses liability and resolves claims within evaluation.

+ Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

+ Manages subrogation of claims and negotiates settlements.

+ Communicates claim action with claimant and client.

+ Ensures claim files are properly documented and claims coding is correct.

+ Maintains professional client relationships.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Travels as required.

**QUALIFICATIONS**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Four (4) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles as applicable to line-of-business.

+ Excellent oral and written communication skills, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Excellent interpersonal skills

+ Excellent negotiating skills

+ Ability to create and complete comprehensive, accurate and constructive written reports

+ Ability to work in a team environment

+ Ability to meet or exceed Performance Competencies

**WORK ENVIRONMENT**

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

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

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

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

_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_ **_$65,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

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

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

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

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)