Claims Adjusters, Examiners, and Investigators

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

**Job Posting Title**

Claims Processor II

**Job Description Summary**

Responsible and accountable for the accurate and timely claims processing of all claim types. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.

**Job Description**

+ Adjudicates claims and adjustments as required.

+ Resolves claims edits and suspended claims.

+ Maintains and updates required reference materials to adjudicate claims.

+ Provides backup support to other team/group members in the performance of job duties as assigned.

**Responsibilities**

+ Ability to quickly use a 10-key machine

+ Experience with list of ICD-9 codes and Current Procedural Terminology (CPT)

**Work Experience**

Work Experience - Required:

Claims

Work Experience - Preferred:

**Education**

Education - Required:

GED, High School

Education - Preferred:

**Certifications**

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $16.00 - $23.39 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law._

_We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law._

_Prime Therapeutics LLC is a Tobacco-Free Workplace employer._

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].

**Why USAA?**

Let’s do something that really matters.

We have an important mission: serving the members of the military community and their families. It’s both a chance to say thank you and the opportunity to put your talents to work in a meaningful way. To do it right, we need the right people. We’re looking for those who share our values of honesty, integrity, loyalty and service. Because what we do is just as important as how we do it. Come be a part of what makes us so special!

It is all about learning and growing.

Our Customer Service Claims Representative role may be a new career for you. There’s a lot to learn, but the pathway is mapped out and USAA is willing to invest in you! Our comprehensive, fully paid four-month training program includes all training materials, licensing costs, class discussions, hands-on training, e-learning modules, and the instructor led guidance will help you to support our members independently.

Our in-office development program provides the training you need and the encouragement to create a proactive and independent support style to service our membership. After six months in-office, you’ll have the opportunity to work offsite 2 days a week. Relocation assistance is not available for this position.

**The Opportunity**

We are currently seeking dedicated professionals to **work in our Phoenix office** for future customer service claims opportunities in **2024** . We have new training classes starting every month. Military veterans and spouses are highly encouraged to apply.

Work schedules will vary and may include some **nights and weekends** . Schedules are assigned based on business needs.

Regularly scheduled shift hours that fall between 6 p.m. and 7 a.m. during the week, or between 6 p.m. Friday and 7 a.m. Monday are eligible for **shift premium pay** .

As a Customer Service Claims Representative you will be part of an outstanding contact service center, where you will focus on providing claims service to members regarding the initial contact on all **auto OR property** First Notice of Loss (FNOL) claims. In addition, you will respond to status inquiries from various parties, document reported losses, set appropriate expectations, provide proactive communications, advice, and empathy to our members.

**What you'll do:**

+ Document First Notice of Loss by acquiring relevant information for effective claim investigation. Set up appropriate services, as needed, to proactively move claims forward to the furthest point in the process within scope of role and expectation.

+ Build loss reports, describe or verify coverage as appropriate, and initiate the most effective method of damage assessment to assign for file handling.

+ Assist with questions regarding the claims process and set expectations for next steps to help ensure claims are successfully resolved and accurately documented.

+ Resolve status inquiries and, when appropriate, route to handling adjuster.

+ Effectively operate in a fast-paced, high-volume, contact center environment taking back-to-back calls and navigating multiple systems and programs while maintaining an engaging member interaction that occurs across multiple communication channels.

+ Apply strong time management skills by closely adhering to assigned work schedule.

+ Embrace continuous improvement and development through coaching and collaboration with manager and team members.

+ Use strong call management skills by assisting members within a timely manner and limiting non-productive time.

+ May assign or initiate emergency services when required on specific claims.

+ Support workload surges and catastrophe (CAT) response operations as needed which may include potential weekends, and/or holiday work outside normal work hours.

+ Work various types of claim loss notices and inquiries, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.

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

**What you have:**

+ High School Diploma or GED

+ Ability to provide exceptional customer service for our members by using active listening, verbal, and written communication skills to communicate clearly, professionally, and empathetically.

+ Highly developed interpersonal skills to collaborate effectively in a fast-paced team environment.

+ Ability to prioritize and multi-task while navigating through multiple business applications.

+ Successful completion of a job-related assessment is required.

+ May require acquisition and maintenance of insurance adjuster license within 90 days. (USAA provides all materials and licensing fees)

**What sets you apart:**

+ US military experience through military service or a military spouse/domestic partner

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

**What we offer:**

**USAA offers Phoenix employees who reside in** **designated service zones** , a fully subsidized, reliable, safe, and employee-centric transportation solution. The service zone includes all areas connecting to **Tempe: Ahwatukee,- Alhambra, Central Phoenix, Chandler, Gilbert, Maricopa,** **Mesa, Paradise Valley, Queen Creek, Scottsdale.** This convenient service will transport employees from a designated park & ride location to the Phoenix Campus.

**Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. The hiring range for this position is: $ 43,750 to $45,750 **.**

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

**Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com.

_Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._

_USAA 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, or status as a protected veteran._

**If you are an existing USAA employee, please use the internal career site in OneSource to apply.**

**Please do not type your first and last name in all caps.**

**_Find your purpose. Join our mission._**

USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity.

USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself – you just need to share our passion for serving our more than 13 million members.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

California applicants, please review our HR CCPA - Notice at Collection (https://statmcstg.usaa.com/mcontent/static\_assets/Media/enterprise\_hr\_cpra\_notice\_at\_collection.pdf) here.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

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

Commercial Auto Claims Representative - Liability

**PRIMARY PURPOSE** : To analyze and process low to mid-level auto physical damage claims. Commercial auto claims experience is preferred. Having a current New York adjuster's license is optimal but not required.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes auto property damage claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.

+ Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

+ Maintains professional client relations.

+ Performs coverage, liability, and damage analysis on all claims assignments.

**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. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Three (3) years of personal line or commercial line auto physical damage claims management experience or equivalent combination of education and experience required to include knowledge of construction basics. Property estimating software experience a plus.

**Skills & Knowledge**

+ Familiarity with personal and commercial lines policies and endorsements

+ Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims.

+ Knowledge of total loss processing, State salvage forms and title requirements.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal 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

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

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.

**Pay Transparency:**

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 $55,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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

Auto Liability Bodily Injury Claims Examiner

**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.

+ Responsible for litigation process on litigated claims.

+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.

+ Reports large claims to excess carrier(s).

+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

**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. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.

**Skills & Knowledge**

+ In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws

+ Knowledge of medical terminology for claim evaluation and Medicare compliance

+ Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.

+ Strong oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Strong organizational skills

+ Strong interpersonal skills

+ Good 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

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

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.

**Pay Transparency:**

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 $70,000. 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.

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

Auto Liability Bodily Injury Claims Examiner

**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.

+ Responsible for litigation process on litigated claims.

+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.

+ Reports large claims to excess carrier(s).

+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

**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. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.

**Skills & Knowledge**

+ In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws

+ Knowledge of medical terminology for claim evaluation and Medicare compliance

+ Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.

+ Strong oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Strong organizational skills

+ Strong interpersonal skills

+ Good 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

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

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.

**Pay Transparency:**

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 $70,000. 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.

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

Auto Liability Bodily Injury Claims Examiner

**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.

+ Responsible for litigation process on litigated claims.

+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.

+ Reports large claims to excess carrier(s).

+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

**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. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.

**Skills & Knowledge**

+ In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws

+ Knowledge of medical terminology for claim evaluation and Medicare compliance

+ Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.

+ Strong oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Strong organizational skills

+ Strong interpersonal skills

+ Good 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

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

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.

**Pay Transparency:**

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 $70,000. 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.

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

Commercial Auto Claims Representative - Liability

**PRIMARY PURPOSE** : To analyze and process low to mid-level auto physical damage claims. Commercial auto claims experience is preferred. Having a current New York adjuster's license is optimal but not required.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes auto property damage claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.

+ Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

+ Maintains professional client relations.

+ Performs coverage, liability, and damage analysis on all claims assignments.

**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. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Three (3) years of personal line or commercial line auto physical damage claims management experience or equivalent combination of education and experience required to include knowledge of construction basics. Property estimating software experience a plus.

**Skills & Knowledge**

+ Familiarity with personal and commercial lines policies and endorsements

+ Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims.

+ Knowledge of total loss processing, State salvage forms and title requirements.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal 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

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

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.

**Pay Transparency:**

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 $55,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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

Commercial Auto Claims Representative - Liability

**PRIMARY PURPOSE** : To analyze and process low to mid-level auto physical damage claims. Commercial auto claims experience is preferred. Having a current New York adjuster's license is optimal but not required.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Processes auto property damage claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.

+ Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.

+ Identifies and pursues subrogation opportunities; secures and disposes of salvage.

+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.

+ Maintains professional client relations.

+ Performs coverage, liability, and damage analysis on all claims assignments.

**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. Secure and maintain the State adjusting licenses as required for the position.

**Experience**

Three (3) years of personal line or commercial line auto physical damage claims management experience or equivalent combination of education and experience required to include knowledge of construction basics. Property estimating software experience a plus.

**Skills & Knowledge**

+ Familiarity with personal and commercial lines policies and endorsements

+ Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims.

+ Knowledge of total loss processing, State salvage forms and title requirements.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal 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

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

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.

**Pay Transparency:**

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 $55,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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)

**Who Are We?**

Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

**Job Category**

Claim, Legal

**Compensation Overview**

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

**Salary Range**

$151,500.00 - $250,000.00

**Target Openings**

1

**What Is the Opportunity?**

Bond & Specialty Insurance (BSI) provides management and professional liability, cyber, crime insurance, and surety bonds to or on behalf of businesses of all sizes. The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to optimize claim results. As a valued member of our team, in addition to claim, you also will provide legal advice to our underwriting colleagues and non-attorney claim colleagues, and participate in BSI claim strategic initiatives. Travelers' Cyber Claim Team is responsible for handling claims focusing on cyber privacy and security breach incident response, computer crime, infrastructure attacks and restoration, notification to affected parties and regulators, business interruption, consumer privacy liability, and identity fraud/theft. The First-Party Cyber Claim Team partners with and supports business units including Private-Non-Profit, Public Companies, Financial Institutions, Insurance Companies, Investment Advisors, and Professional Liability.

**What Will You Do?**

**•** Manage a team of claim professionals and counsel.

• Analyze, investigate, and resolve BSI claims of high levels of severity with oversight from claims management.

• Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.

• Retain, monitor, and manage outside counsel actively utilizing litigation management plans and budgets.

• Communicate with underwriting on significant claim exposures.

• Identify all recovery opportunities and coordinate recovery efforts with the Recovery Management Unit and Claim management.

• Travel to and attend mediations, settlement conferences, claim conferences, field office visits, trials and depositions.

• Refine policy interpretation/coverage analysis skills including drafting coverage opinions with case law included.

• Negotiate settlements/resolutions, review releases and settlement agreements, including confidentiality and non-disclosure provisions.

• Support underwriting marketing efforts, including participation in broker and account visits and risk mitigation seminars and authoring customer-focused white papers and articles.

• Monitor marketplace conditions, conduct research, and draft reference materials to inform claim and underwriting colleagues on law impacting Travelers’ underwriting and claim decisions.

• Obtain and maintain required adjusters’ licenses.

**What Will Our Ideal Candidate Have?**

+ Eight or more years of relevant legal or claim handling work experience.

+ Demonstrated ability to effectively work through conflict and resolve issues with a professional demeanor.

+ Ability to make sound decisions and negotiate terms and conditions within designated authority limit.

+ Excellent verbal and written communication skills with the ability to clearly articulate coverage determinations.

+ Time management skills with the ability to manage multiple priorities with an attention to detail, data and analytics.

+ Ability to build, foster, and maintain effective and collaborative relationships with colleagues, customers, and business partners.

**What is a Must Have?**

+ Bachelor’s Degree.

+ Juris Doctorate Degree.

+ Properly licensed, registered or authorized, and in good standing, to practice law in the jurisdiction in which you will be working.

+ Five years of relevant legal experience.

**What Is in It for You?**

+ **Health Insurance** : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.

+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.

+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.

+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.

+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

**Employment Practices**

Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ([email protected]) so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ .

Job Summary:

Handle all standard claims types, in both lead and following capacity. Ensure claims handled within authority limits, and in line with Claims Standards procedures and guidelines. Utilize third party service providers to achieve economical results and to provide a high quality service to all internal and external customers. Develop and maintain relationships with brokers and clients.

Key Responsibilities:

-Claims Processing and Administration

Input and maintain accurate claims records for designated accounts, within appropriate Claims administration systems

Proactively review late/non payment of premium and support credit control process with Underwriting / Accounts

Manage timely production of management information reports (e.g. monthly major claims movements) and proactively identify loss trends

-Investigation and Reserving of Claims

Investigate standard claims, including coverage determination and evaluation of loss exposures

Determine appropriate reserving levels

-Settlement

Settle standard claims through payment or denial

Negotiate to ensure efficient and competitive settlement

Qualifications:

Proven track record in Inland Marine (Marine Cargo) Claims handling. Understanding of LoB products and portfolio with some technical specialists knowledge. Management of systems

Minimum - 5 years

Experience Level:

Intermediate Level

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.