Financial Services

Claims Adjusters, Examiners, and Investigators

Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures.

Salary Breakdown

Claims Adjusters, Examiners, and Investigators

Average

$59,030

ANNUAL

$28.38

HOURLY

Entry Level

$37,760

ANNUAL

$18.16

HOURLY

Mid Level

$55,350

ANNUAL

$26.61

HOURLY

Expert Level

$80,370

ANNUAL

$38.64

HOURLY


Current Available & Projected Jobs

Claims Adjusters, Examiners, and Investigators

63

Current Available Jobs

13,320

Projected job openings through 2032


Sample Career Roadmap

Claims Adjusters, Examiners, and Investigators

Job Titles

Entry Level

JOB TITLE

Entry-level Adjuster

Mid Level

JOB TITLE

Mid-level Adjuster

Expert Level

JOB TITLE

Senior Adjuster, or Partner

Supporting Programs

Claims Adjusters, Examiners, and Investigators

Sort by:


Arizona State University
  AZ      Certification

Arizona State University
  AZ      Degree Program

Arizona State University
  AZ      Degree Program

Estrella Mountain Community College
  Avondale, AZ 85392      Degree Program

University of Arizona
  Tucson, AZ 85721-0066      Degree Program

University of Arizona
  Tucson, AZ 85721-0066      Degree Program

University of Arizona
  Tucson, AZ 85721-0066      Degree Program

Top Expected Tasks

Claims Adjusters, Examiners, and Investigators


Knowledge, Skills & Abilities

Claims Adjusters, Examiners, and Investigators

Common knowledge, skills & abilities needed to get a foot in the door.

KNOWLEDGE

Customer and Personal Service

KNOWLEDGE

English Language

KNOWLEDGE

Administrative

KNOWLEDGE

Mathematics

KNOWLEDGE

Computers and Electronics

SKILL

Reading Comprehension

SKILL

Active Listening

SKILL

Critical Thinking

SKILL

Speaking

SKILL

Judgment and Decision Making

ABILITY

Written Comprehension

ABILITY

Oral Comprehension

ABILITY

Oral Expression

ABILITY

Deductive Reasoning

ABILITY

Inductive Reasoning


Job Opportunities

Claims Adjusters, Examiners, and Investigators

  • STAT/PFL Claims Specialist
    Lincoln Financial    Phoenix, AZ 85067
     Posted about 14 hours    

    **Alternate Locations:** Work from Home; Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Omaha, NE (Nebraska)

    **Work Arrangement:**

    Remote : Work at home employee

    **Relocation assistance:** is not available for this opportunity.

    **Requisition #:** 74669

    **The Role at a Glance**

    We are excited to bring on highly motivated STAT / PFL Claims Specialists to staff our ever-growing claims organization.

    As a STAT / PFL Claims Specialist, you will be responsible for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You’ll complete a thorough training to develop new skills and give you the confidence you need to be successful in your new role. If you enjoy working in a fast-paced team environment from the comfort of your own home, then please read on!

    **What you'll be doing**

    + Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding the Short Term Disability claim.

    + Collaborating with fellow case managers, nurse case managers and consulting physicians to make appropriate and timely claim determinations.

    + Reviewing complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning

    + Completing accurate financial calculations consistent with company and state guidelines.

    + Providing exceptional customer service and proactively recognizing customer needs and areas of opportunity.

    **What we’re looking for**

    _Must haves:_

    + High School diploma or GED

    + 1-2 years of experience in claims, leaves or customer service

    + Strong written and verbal communication skills

    + Excellent organization skills with the ability to multi-task

    _Nice to haves_ :

    + Experience with disability and/or absence management

    + Strong mathematical skills for payment calculations

    **Application Deadline**

    Applications for this position will be accepted through June 7, 2025 subject to earlier closure due to applicant volume.

    **What’s it like to work here?**

    At Lincoln Financial, we love what we do. We make meaningful contributions each and every day to empower our customers to take charge of their lives. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future.

    **What’s in it for you:**

    + Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes

    + Leadership development and virtual training opportunities

    + PTO/parental leave

    + Competitive 401K and employee benefits (https://www.lincolnfinancial.com/public/aboutus/careers/lifeatlincoln#benefits)

    + Free financial counseling, health coaching and employee assistance program

    + Tuition assistance program

    + Work arrangements that work for you

    + Effective productivity/technology tools and training

    The pay range for this position is $22.59 - $30.12 with **anticipated pay for new hires between the minimum and midpoint of the range** and could vary above and below the listed range as permitted by applicable law. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln’s total rewards package for employees. In addition, the role may be eligible for the Annual Incentive Program, which is discretionary and based on the performance of the company, business unit and individual. Other rewards may include long-term incentives, sales incentives and Lincoln’s standard benefits package.

    **About The Company**

    Lincoln Financial (NYSE: LNC) helps people to confidently plan for their version of a successful future. We focus on identifying a clear path to financial security, with products including annuities, life insurance, group protection, and retirement plan services.

    With our 120-year track record of expertise and integrity, millions of customers trust our solutions and service to help put their goals in reach.

    Lincoln Financial Distributors, a broker-dealer, is the wholesale distribution organization of Lincoln Financial. Lincoln Financial is the marketing name for Lincoln Financial Corporation and its affiliates including The Lincoln National Life Insurance Company, Fort Wayne, IN, and Lincoln Life & Annuity Company of New York, Syracuse, NY. Lincoln Financial affiliates, their distributors, and their respective employees, representatives and/or insurance agents do not provide tax, accounting or legal advice.

    Lincoln is committed to creating a diverse and inclusive (https://www.lincolnfinancial.com/public/aboutus/companyoverview/ourvalues/diversityinclusion) environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

    Follow us on Facebook (https://www.facebook.com/lincolnfinancial/) , X (https://mobile.twitter.com/lincolnfingroup) , LinkedIn (https://www.linkedin.com/company/lincolnfinancial/) , Instagram (https://www.instagram.com/lincolnfinancial/) , and YouTube (https://www.youtube.com/@Lincoln\_Financial) . For the latest company news, visit our newsroom (https://www.lincolnfinancial.com/public/aboutus/newsroom) .

    **Be Aware of Fraudulent Recruiting Activities**

    If you are interested in a career at Lincoln, we encourage you to review our current openings and apply on our website. Lincoln values the privacy and security of every applicant and urges all applicants to diligently protect their sensitive personal information from scams targeting job seekers. These scams can take many forms including fake employment applications, bogus interviews and falsified offer letters.

    Lincoln will not ask applicants to provide their social security numbers, date of birth, bank account information or other sensitive information in job applications. Additionally, our recruiters do not communicate with applicants through free e-mail accounts (Gmail, Yahoo, Hotmail) or conduct interviews utilizing video chat rooms. We will never ask applicants to provide payment during the hiring process or extend an offer without conducting a phone, live video or in-person interview. Please contact Lincoln's fraud team at fraudhotline@lfg.com if you encounter a recruiter or see a job opportunity that seems suspicious.

    **Additional Information**

    This position may be subject to Lincoln’s Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln’s current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities.

    Any unsolicited resumes or candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial are considered property of Lincoln Financial and are not subject to payment of agency fees.

    Lincoln Financial is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, Veteran status, or genetic information. Applicants are evaluated on the basis of job qualifications. If you are a person with a disability that impedes your ability to express your interest for a position through our online application process, or require TTY/TDD assistance, contact us by calling 260-455-2558.

    This Employer Participates in E-Verify. See the E-Verify (https://www.e-verify.gov) notices.

    Este Empleador Participa en E-Verify. Ver el E-Verify (https://www.e-verify.gov/es) avisos.

    Lincoln Financial Group ("LFG") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, veterans status, or genetic information. Opportunities throughout LFG are available to employees and applicants and are evaluated on the basis of job qualifications. We have a drug free work environment and we perform pre-employment substance abuse testing.


    Employment Type

    Full Time

  • Senior Fraud and Claims Management Capacity Planning Consultant
    Wells Fargo    CHANDLER, AZ 85286
     Posted 1 day    

    **About this role:**

    Wells Fargo is seeking a Senior Business Execution Consultant on the Workforce Management team within Consumer and Small Business Banking Operations (CSBBO). This execution consultant will develop analysis and models to optimize workforce staff in large telephony and back-office operations organizations. To be successful in this role, the individual will possess a strong understanding of back-office workforce management, capacity planning/forecast modeling for operations, contact center and business utility functions. The workforce management team works to support staffing strategies to include tactical forecasting and scheduling, real-time capacity monitoring, capacity planning, and back-office workload support for CSBBO contact centers and delivery teams. Learn more about our career areas and lines of business at wellsfargojobs.com.

    **In this role, you will:**

    + Review and research moderately complex business, operational, and technical challenges that require an in-depth evaluation of variable factors.

    + Manage all activities related to their staffing models including what-if and trend analysis, requirement gathering, cost/benefit analysis, process analysis and mapping/improvement projects. Will also serve as the subject matter expert for their assigned area of responsibility.

    + Perform solution-based strategic thinking to enable the business to operate as leanly as possible without sacrificing quality or risking metric results.

    + Monitor and publish results to plan, identify gaps and lead remediation strategy with operations leadership.

    + Be responsible for the development and ongoing administration of the long-term capacity planning models (which forecast volume, productivity, shrinkage and headcount needs to meet required business objectives)

    + Partner with various departments to ensure a thorough understanding of operational strategies while ensuring that the Capacity Plans accurately reflect those strategies.

    + Identify strategic recommendations on how to optimize our workforce.

    + Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures

    + Communicate and coordinate with various departments including Operations, Finance, Workforce Management Support, and other partners.

    + Work both independently and in partnership with global leadership developing strong relationships with remote partners through the creation and communication of polished analysis and PowerPoint presentations built to inform and recommend strategies to Sr. Leadership

    + Manage or participate in large cross group projects and mentor less experienced staff.

    **As a successful candidate, you will have:**

    + The ability to think creatively to build out advanced Excel spreadsheets from scratch.

    + Excellent capabilities with Microsoft Excel Pivot Tables/Data Analysis/Database knowledge

    + The ability to analyze, review, forecast, and trend complex data – creating “what if” models, identifying viable options to enable data-driven decisions that supports business objectives.

    + Strategic planning, problem solving, analytical skills and the ability to balance multiple tasks simultaneously.

    + The ability to plan, prioritize, organize, and complete work to meet established objectives.

    + Strong written and verbal communication skills that convey the ability to synthesize complex concepts into easy to digest formats for senior leaders.

    + The ability to maintain composure in critical situations and communicate effectively.

    + A high level of professionalism, integrity, and maturity

    + Excellent interpersonal and collaboration skills with a global team

    + Strong technical skills including Microsoft Office Suite and Teams

    **Required Qualifications:**

    + 4+ years of Analytics experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.

    **Desired Qualifications:**

    + 4+ years' workforce management and/or workforce optimization experience

    + 4+ years of performing telephony and/or back-office forecasting to assess volume and FTE need.

    + Ability to gather and analyze data and synthesize models to optimize workforce staffing.

    + Experience with call center workforce management tools (Aspect, Verint, IEX, Nice, etc)

    + 3+ years of experience using advanced level of proficiency in MS Excel working with large data sets, including ability to utilize VLOOKUPs, create pivot tables and graphs, and incorporate standard formulas and functions.

    + Ability to influence across all organizational levels, particularly senior management.

    + Ability to quickly establish credibility to build and maintain effective working relationships.

    + Ability to effectively communicate, verbally and written, with executive level presence with the ability to translate complex analysis and insights into relevant business discussions with diverse groups of leaders and organizations.

    **Job Expectations:**

    + Ability to travel up to 10% of the time

    + This position is not eligible for Visa sponsorship.

    **Posting End Date:**

    1 Jun 2025

    **_*Job posting may come down early due to volume of applicants._**

    **We Value Equal Opportunity**

    Wells Fargo is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected characteristic.

    Employees support our focus on building strong customer relationships balanced with a strong risk mitigating and compliance-driven culture which firmly establishes those disciplines as critical to the success of our customers and company. They are accountable for execution of all applicable risk programs (Credit, Market, Financial Crimes, Operational, Regulatory Compliance), which includes effectively following and adhering to applicable Wells Fargo policies and procedures, appropriately fulfilling risk and compliance obligations, timely and effective escalation and remediation of issues, and making sound risk decisions. There is emphasis on proactive monitoring, governance, risk identification and escalation, as well as making sound risk decisions commensurate with the business unit’s risk appetite and all risk and compliance program requirements.

    Candidates applying to job openings posted in Canada: Applications for employment are encouraged from all qualified candidates, including women, persons with disabilities, aboriginal peoples and visible minorities. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process.

    **Applicants with Disabilities**

    To request a medical accommodation during the application or interview process, visit Disability Inclusion at Wells Fargo (https://www.wellsfargojobs.com/en/diversity/disability-inclusion/) .

    **Drug and Alcohol Policy**

    Wells Fargo maintains a drug free workplace. Please see our Drug and Alcohol Policy (https://www.wellsfargojobs.com/en/wells-fargo-drug-and-alcohol-policy) to learn more.

    **Wells Fargo Recruitment and Hiring Requirements:**

    a. Third-Party recordings are prohibited unless authorized by Wells Fargo.

    b. Wells Fargo requires you to directly represent your own experiences during the recruiting and hiring process.

    **Req Number:** R-461919


    Employment Type

    Full Time

  • Senior Fraud and Claims Management Capacity Planning Consultant
    Wells Fargo    PHOENIX, AZ 85067
     Posted 1 day    

    **About this role:**

    Wells Fargo is seeking a Senior Business Execution Consultant on the Workforce Management team within Consumer and Small Business Banking Operations (CSBBO). This execution consultant will develop analysis and models to optimize workforce staff in large telephony and back-office operations organizations. To be successful in this role, the individual will possess a strong understanding of back-office workforce management, capacity planning/forecast modeling for operations, contact center and business utility functions. The workforce management team works to support staffing strategies to include tactical forecasting and scheduling, real-time capacity monitoring, capacity planning, and back-office workload support for CSBBO contact centers and delivery teams. Learn more about our career areas and lines of business at wellsfargojobs.com.

    **In this role, you will:**

    + Review and research moderately complex business, operational, and technical challenges that require an in-depth evaluation of variable factors.

    + Manage all activities related to their staffing models including what-if and trend analysis, requirement gathering, cost/benefit analysis, process analysis and mapping/improvement projects. Will also serve as the subject matter expert for their assigned area of responsibility.

    + Perform solution-based strategic thinking to enable the business to operate as leanly as possible without sacrificing quality or risking metric results.

    + Monitor and publish results to plan, identify gaps and lead remediation strategy with operations leadership.

    + Be responsible for the development and ongoing administration of the long-term capacity planning models (which forecast volume, productivity, shrinkage and headcount needs to meet required business objectives)

    + Partner with various departments to ensure a thorough understanding of operational strategies while ensuring that the Capacity Plans accurately reflect those strategies.

    + Identify strategic recommendations on how to optimize our workforce.

    + Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures

    + Communicate and coordinate with various departments including Operations, Finance, Workforce Management Support, and other partners.

    + Work both independently and in partnership with global leadership developing strong relationships with remote partners through the creation and communication of polished analysis and PowerPoint presentations built to inform and recommend strategies to Sr. Leadership

    + Manage or participate in large cross group projects and mentor less experienced staff.

    **As a successful candidate, you will have:**

    + The ability to think creatively to build out advanced Excel spreadsheets from scratch.

    + Excellent capabilities with Microsoft Excel Pivot Tables/Data Analysis/Database knowledge

    + The ability to analyze, review, forecast, and trend complex data – creating “what if” models, identifying viable options to enable data-driven decisions that supports business objectives.

    + Strategic planning, problem solving, analytical skills and the ability to balance multiple tasks simultaneously.

    + The ability to plan, prioritize, organize, and complete work to meet established objectives.

    + Strong written and verbal communication skills that convey the ability to synthesize complex concepts into easy to digest formats for senior leaders.

    + The ability to maintain composure in critical situations and communicate effectively.

    + A high level of professionalism, integrity, and maturity

    + Excellent interpersonal and collaboration skills with a global team

    + Strong technical skills including Microsoft Office Suite and Teams

    **Required Qualifications:**

    + 4+ years of Analytics experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.

    **Desired Qualifications:**

    + 4+ years' workforce management and/or workforce optimization experience

    + 4+ years of performing telephony and/or back-office forecasting to assess volume and FTE need.

    + Ability to gather and analyze data and synthesize models to optimize workforce staffing.

    + Experience with call center workforce management tools (Aspect, Verint, IEX, Nice, etc)

    + 3+ years of experience using advanced level of proficiency in MS Excel working with large data sets, including ability to utilize VLOOKUPs, create pivot tables and graphs, and incorporate standard formulas and functions.

    + Ability to influence across all organizational levels, particularly senior management.

    + Ability to quickly establish credibility to build and maintain effective working relationships.

    + Ability to effectively communicate, verbally and written, with executive level presence with the ability to translate complex analysis and insights into relevant business discussions with diverse groups of leaders and organizations.

    **Job Expectations:**

    + Ability to travel up to 10% of the time

    + This position is not eligible for Visa sponsorship.

    **Posting End Date:**

    1 Jun 2025

    **_*Job posting may come down early due to volume of applicants._**

    **We Value Equal Opportunity**

    Wells Fargo is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected characteristic.

    Employees support our focus on building strong customer relationships balanced with a strong risk mitigating and compliance-driven culture which firmly establishes those disciplines as critical to the success of our customers and company. They are accountable for execution of all applicable risk programs (Credit, Market, Financial Crimes, Operational, Regulatory Compliance), which includes effectively following and adhering to applicable Wells Fargo policies and procedures, appropriately fulfilling risk and compliance obligations, timely and effective escalation and remediation of issues, and making sound risk decisions. There is emphasis on proactive monitoring, governance, risk identification and escalation, as well as making sound risk decisions commensurate with the business unit’s risk appetite and all risk and compliance program requirements.

    Candidates applying to job openings posted in Canada: Applications for employment are encouraged from all qualified candidates, including women, persons with disabilities, aboriginal peoples and visible minorities. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process.

    **Applicants with Disabilities**

    To request a medical accommodation during the application or interview process, visit Disability Inclusion at Wells Fargo (https://www.wellsfargojobs.com/en/diversity/disability-inclusion/) .

    **Drug and Alcohol Policy**

    Wells Fargo maintains a drug free workplace. Please see our Drug and Alcohol Policy (https://www.wellsfargojobs.com/en/wells-fargo-drug-and-alcohol-policy) to learn more.

    **Wells Fargo Recruitment and Hiring Requirements:**

    a. Third-Party recordings are prohibited unless authorized by Wells Fargo.

    b. Wells Fargo requires you to directly represent your own experiences during the recruiting and hiring process.

    **Req Number:** R-461919


    Employment Type

    Full Time

  • Auto Claims Adjuster
    Sedgwick    Phoenix, AZ 85067
     Posted 1 day    

    By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

    Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

    Certified as a Great Place to Work®

    Fortune Best Workplaces in Financial Services & Insurance

    Auto 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 $25.00 to $35.00 USD/HR . This role is eligible for 401k.

    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.**

    **Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**


    Employment Type

    Full Time

  • Social Security Claims Specialist
    Lincoln Financial    Phoenix, AZ 85067
     Posted 2 days    

    **Alternate Locations:** Work from Home; Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Omaha, NE (Nebraska)

    **Work Arrangement:**

    Remote : Work at home employee

    **Relocation assistance:** is not available for this opportunity.

    **Requisition #:** 74640

    **The Role at a Glance**

    We are excited to bring on a Social Security Specialist to join our Financial Services Organization supporting Group Protection. In this role you will perform and deliver on routine and non-routine Social Security Disability Insurance (SSDI) assignments independently in accordance with established procedures/guidelines. You will act as a liaison between internal benefits teams, claimants, and any legal representation. You will provide claimants with detailed information regarding SSDI benefits and how such benefits can be used in conjunction with disability insurance policies. You will monitor claimants’ SS claims until a final decision is received.

    **What you'll be doing**

    + Supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility.

    + Meets or exceeds departmental quality and service standards.

    + Works overtime as needed.

    + Delivers routine work independently, in accordance with established procedures and guidelines, in a timely manner and meets deadlines appropriately.

    + Makes routine & non-routine decisions, applying limited but increasingly more discretion within role except for matters of significance which affect the business as a whole or a significant part of it, in accordance with established procedures & guidelines

    + Applies expanded knowledge obtained from the role in increasingly more complex situations and continues to acquire more knowledge to apply in role.

    + Provides a diverse range of information and performs a diverse range of tasks/transactions related to common programs and services.

    + Reviews and interprets disability insurance policies with specific attention to provisions related to other income and/or offsets.

    + Contacts and educates claimants eligible for SSDI benefits. Explains both the differences and coordination between the disability policy/benefits and the SSA's benefits/adjudication.

    + Provides initial guidance and continues on-going communication with claimants regarding their SS responsibilities and follow-up items until a final determination is made.

    + Accurately posts SS offsets in applicable system(s).

    + Develops and maintains working relationships with SSDI vendors and/or claimant attorneys.

    + Works closely with internal benefits/claims teams; regularly providing information and updates regarding Social Security eligibility and determinations.

    + Recognizes issues and raises concerns to management, with recommendations for improvement.

    + Takes initiative to investigate issues and identify root causes; recommends solutions to improve operational effectiveness.

    + Maintains and updates knowledge of SSDI guidelines and departmental policies & procedures.

    **What we’re looking for**

    Must-have experience (Required):

    + High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required)

    + 2 - 3 Years’ experience in claims or other insurance operations directly aligned to the specific duties for this role OR for candidates with an Associate degree or above, 0-1 year experience in claims or other insurance operations directly aligned to the role (Required)

    + Effective strong written and verbal communication skills.

    + Ability to maneuver through multiple systems/databases/platforms/software.

    + Ability to be adaptable/flexible as business needs change.

    Nice-to have Experience (Preferred):

    + Ability to problem solve and make independent decisions, while providing compassionate customer service.

    + Research and data entry experience in a fast-paced environment.

    + Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

    **Application Deadline**

    Applications for this position will be accepted through June 6, 2025, subject to earlier closure due to applicant volume.

    **Level:** N3-1

    The pay range for this position is $22.59 - $30.12 with **anticipated pay for new hires between the minimum and midpoint of the range** and could vary above and below the listed range as permitted by applicable law. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln’s total rewards package for employees. In addition, the role may be eligible for the Annual Incentive Program, which is discretionary and based on the performance of the company, business unit and individual. Other rewards may include long-term incentives, sales incentives and Lincoln’s standard benefits package.

    **Additional Information**

    This position may be subject to Lincoln’s Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln’s current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities. Any unsolicited resumes/candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial are considered property of Lincoln Financial and are not subject to payment of agency fees.

    Lincoln Financial is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, Veteran status, or genetic information. Opportunities throughout Lincoln Financial are available to employees and applicants and are evaluated on the basis of job qualifications. We have a drug free work environment and we perform pre-employment substance abuse testing.

    Benefits at a Glance (https://hrdirectdocs.lfg.com/misc/HR/Recruiting/BenefitsResourcesGuide.pdf)

    This Employer Participates in E-Verify. See the E-Verify (https://www.e-verify.gov/) notices.

    Este Empleador Participa en E-Verify. Ver el E-Verify (https://www.e-verify.gov/es) avisos.

    Lincoln Financial Group ("LFG") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, veterans status, or genetic information. Opportunities throughout LFG are available to employees and applicants and are evaluated on the basis of job qualifications. We have a drug free work environment and we perform pre-employment substance abuse testing.


    Employment Type

    Full Time

  • Auto Liability Claims Adjuster
    Kemper    Phoenix, AZ 85067
     Posted 2 days    

    Location(s)

    Phoenix, Arizona

    **Details**

    Kemper is one of the nation’s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper’s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises.

    **Position Summary** :

    Who says you can't have it all? We have an immediate opening for an experienced insurance professional with the ability to investigate and adjust first-party and third-party automobile claims. We are offering the opportunity to work in a fast-paced and exciting environment, while you grow your career! We are currently looking for Auto Liability Claims Adjusters to investigate claims, determine liability, confirm coverage, establishes damages, and negotiate settlement of claims.

    **Position Responsibilities** :

    + Take statements from insureds, claimants, and witnesses

    + Obtain and review evidence, reports, and medical records

    + Investigate losses and identify coverage issues

    + Negotiate settlements with claimants and claimant’s attorneys

    **Position Qualifications** :

    + Bachelor’s degree or a minimum of 2 plus years of auto insurance related experience required.

    + 1+ years of liability claims handling experience

    + Understanding of full in-depth auto coverage for non-standard claims preferred

    + California auto claims handling experience a plus

    + Claim-related computer systems experience required; Guidewire experience preferred

    + Bilingual in Spanish is a plus

    + This is a remote Phoenix, AZ position.

    The range for this position is $46,400.00 - $77,300.00. When determining candidate offers, we consider experience, skills, education, certifications, and geographic location among other factors. This job is also eligible for our Kemper benefits package (Medical, Dental, Vision, PTO, 401k, etc.)

    Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination.

    Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.

    Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it.

    \#LI-MV1

    **Kemper at a Glance**

    The Kemper family of companies is one of the nation’s leading specialized insurers. With approximately $13 billion in assets, Kemper is improving the world of insurance by providing affordable and easy-to-use personalized solutions to individuals, families and businesses through its Kemper Auto and Kemper Life brands. Kemper serves over 4.8 million policies, is represented by approximately 22,200 agents and brokers, and has approximately 7,500 associates dedicated to meeting the ever-changing needs of its customers. Learn more at Kemper.com .

    *Alliance United Insurance Company is not rated.

    _We value diversity and strive to be an employer of choice. An Equal Opportunity Employer, M/F/D/V_

    **Our employees enjoy great benefits:**

    • Qualify for your choice of health and dental plans within your first month.

    • Save for your future with robust 401(k) match, Health Spending Accounts and various retirement plans.

    • Learn and Grow with our Tuition Assistance Program, paid certifications and continuing education programs.

    • Contribute to your community through United Way and volunteer programs.

    • Balance your life with generous paid time off and business casual dress.

    • Get employee discounts for shopping, dining and travel through Kemper Perks.


    Employment Type

    Full Time

  • Mechanical Claims Adjuster (Remote)
    DriveTime    Mesa, AZ 85213
     Posted 3 days    

    **What’s Under the Hood**

    DriveTime Family of Brands includes SilverRock, which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative services encompassing everything from GAP coverage to vehicle theft and GPS tracking to dealership fleet management. Our ancillary product expertise is proven with over 1 million service contracts, products, and warranties, and over $300 million in claims.

    **That’s Nice, But What’s the Job?**

    In short, as a Claims Adjuster, you will use your knowledge of vehicle systems and repairs to validate, approve, and authorize payment for repair recommendations on warranty claims. You’ll work over the phone with service advisers and technicians to ensure correct repairs are performed to help get our customers back on the road, so automotive experience is a must!

    **So What Kind of Folks Are We Looking for?**

    + **Passionate and goal-oriented.** We are looking for someone that is enthusiastic about their career and is passionate about meeting and exceeding their goals.

    + **Excellent verbal and written communication skills.** The ability to talk and write with confidence, charisma, and competence to a wide variety of audiences.

    + **Agile in a fast-paced environment** . We move, and we move quickly. Thriving in and contributing to an environment that never stops is a must.

    + **Plays well with others.** You will be working in a high-functioning team environment. We work together and we win together.

    + **Works well in a time crunch.** There will be multiple time-sensitive requirements and you will need the ability to meet deliverable due dates.

    + **Fantastic problem solver!** Some calls will be challenging. Your goal is not only to find the problem but more importantly, find the solution.

    + **Positive emotional resilience.** This is an environment where you will be faced with challenging calls on a daily basis. We want to make sure you have the ability to rise past them while maintaining an optimistic attitude.

    **The Specifics.**

    + High School diploma required; Associate or Bachelor’s deree is preferred

    + 3 + years of experience with current automotive mechanical and diagnostics

    + **_Must be located in AZ, FL, GA, NC, TN, TX, UT or NV._**

    **So What About the Perks? Perks matter**

    + **Work From Home.** Feel free to rock the casual wear while still being camera ready. You will be working from your home office (in an approved city & state) and make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

    + **Medical, dental, and vision, oh my!** DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage.

    + **But Wait, There’s More.** 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few.

    + **Growth Opportunities.** You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year.

    + **Tuition Reimbursement.** We’re as passionate about your professional development as you are. With that, we’ll put our money where our mouth is.

    + **Wellness Program.** Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities!

    + **Gratitude is Green.** We offer competitive pay across the organization, because, well… money matters!

    + **Work From Home.** Feel free to rock those yoga pants while still being camera ready, just make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

    + **No Digital Nomads.** We’ll need you to work from your home address that will be in one of the states where we are licensed to do business.

    + **Consistent Work Schedule.** You’ll get a set schedule Monday through Friday, with rotating Saturdays! With that, we do ask for some flexibility and overtime as needed.

    + **If You’re in Town.** For those employees in AZ and TX, we have in-office and hybrid arrangements available. We may even ask to see to see you in-person occasionally.

    + **Game Room.** Gimme a break – no, not a Kit Kat ad but we do have a ping-pong table, a pool table and other games if you ever need a break in your day.

    + **In-House Gym.** We want our employees to be the best versions of themselves. So come early, take a break in your day, or finish strong with a workout!

    + **Enjoy Social Events?** Bring it on. Rally with your team for festive gatherings, team competitions or just to hang out!

    + **We Care and Value YOU!** Feel the love and let us treat you to company outings, personal rewards, amazing prizes & much more!

    + **Paid Time Off.** Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn!

    **Anything Else? Absolutely.**

    DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we’ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don’t forget Phoenix Business Journal Healthiest Employers (okay, we’ll stop there)!

    Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer.

    And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!


    Employment Type

    Full Time

  • Claims Representative - National Remote
    UnitedHealth Group    Phoenix, AZ 85067
     Posted 4 days    

    **UMR, UnitedHealthcare’s** third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with **UMR,** what you do matters. It's that simple . . . and it's that rewarding.

    In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within **UMR** due to our record-breaking growth.

    Regardless of your role at **UMR,** the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.

    This position is full-time (40 hours/week), Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 8:00pm CST. It may be necessary, given the business need, to work occasional overtime.

    We offer 4 – 7 weeks of paid training. The hours during training will be 8:00am – 4:30pm CST, Monday – Friday. 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 in order 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 direction 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 any of our 8-hour shift schedules during our normal business hours of 7:00am – 8:00pm 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 the 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 that 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 $16.88 to $33.22 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._

    _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._

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

    \#RPO


    Employment Type

    Full Time

  • FHA Part B Default Loan Claims Analyst - 100% REMOTE
    TEKsystems    Tempe, AZ 85282
     Posted 4 days    

    Responsible for building a complete document package with all appropriate/applicable supporting invoices, breakdowns, ledgers, foreclosure, bankruptcy, and loss mitigation relevant documents based on a specific claim type in a timely and efficient manner. This position is responsible for adhering to all guidelines set forth by insurer, investor, and master servicing guidelines.

    + Evaluates/reconciles loan level balances (corporate and escrow advances) for expenses incurred to determine claimable vs non claimable to maximize reimbursement on behalf of the servicer and/or client

    + Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits

    + Reviews MI claim Explanation of Benefits (EOB) or Insurer Advice of Payments (AOP) and research curtailment reasons for potential rebuttal

    + Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI companies and/or Insurer.

    + Monitors pre/post conveyance processes on government loans

    + Satisfies audit requests

    + Monitors claim deadlines and exceptions reports

    + Monitors REO activity on investor claim files

    + Ensures all receivables are paid w/ no penalties or interest curtailments

    + Ensures payment to vendors in a timely manner

    + Corresponds with attorney/trustees, vendors, and agency representatives to ensure claims are processed within insurer and investor guidelines

    + Works in conjunction with attorneys, agencies, PMI companies, investors and master servicers to expedite the completion of the claim to minimize losses

    + Complies with and have working knowledge of all FNMA, FHLMC, PMI, FHA, VA, investor and master servicer rules and regulations

    + Performs regular reviews of all cases/claims on a regular basis

    + Requests UPB removal on loans from Investor Reporting Department once the claim process has been completed

    + Assists in the training of new employees

    + Performs other work and duties as assigned

    Skills & Qualifications:

    + Claims analysis, claims preparation, mortgage, default, MSP, loss mitigation, default servicing

    + Must be very strong in Excel and have used Vlookup and Pivot Tables on a consistent daily basis.

    + Working knowledge of the Black Knight MSP servicing system

    + Working knowledge of MS Outlook, Word, Excel, Power Point, and ability to learn industry related systems

    + Able to work both independently and within a team environment

    + Excellent time management skills

    + Working knowledge with Microsoft Office, spreadsheets and software applications

    + Strong analytical skills

    + Excellent verbal and written communication skills

    + Detail oriented with ability to successfully manage multiple priorities

    + Able to work in fast paced environment with the ability to meet deadlines

    Pay and Benefits

    The pay range for this position is $26.00 - $38.00/hr.

    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 hybrid position in Tempe,AZ.

    Application Deadline

    This position is anticipated to close on Jun 6, 2025.

    About TEKsystems and TEKsystems Global Services

    We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

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


    Employment Type

    Full Time

  • Senior Life Science Claims Specialist (REMOTE US)
    Sedgwick    Phoenix, AZ 85067
     Posted 4 days    

    By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

    Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

    Certified as a Great Place to Work®

    Fortune Best Workplaces in Financial Services & Insurance

    Senior Life Science Claims Specialist (REMOTE US)

    **PRIMARY PURPOSE** **:** To analyze complex claims specific to the product liability / life sciences field; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

    **ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

    + Analyzes and processes complex or technically difficult product liability / life sciences 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.

    + Evaluate/draft coverage position letters.

    + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.

    + Negotiates claim settlement up to designated authority level.

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

    + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.

    + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.

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

    + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.

    + Represents Company in depositions, mediations, and trial monitoring as needed.

    + Communicates claim activity and processing with 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.

    + Delegates work and mentors assigned staff.

    **ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

    + Performs other duties as assigned.

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

    **QUALIFICATIONS**

    **Education & Licensing**

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

    **Experience**

    Eight (8) years of claims management experience or equivalent combination of education and experience required.

    **Skills & Knowledge**

    + In-depth knowledge of product liability / life sciences 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 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

    + Excellent negotiation skills

    + Good interpersonal skills

    + Ability to work in a team environment

    + Ability to meet or exceed Performance Competencies

    **WORK ENVIRONMENT**

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

    **Mental** **:** Clear and conceptual thinking ability; excellent judgment, 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

    **NOTE** **:** Credit security clearance, confirmed via a background credit check, is required for this position.

    _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_ **_$110,000- $120,000._** _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.**

    **Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**


    Employment Type

    Full Time


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