Claims Adjusters, Examiners, and Investigators

Description

Our client, in the healthcare industry focused in Behavioral Health, is in need for a Medical Billing/Claims specialist near downtown Tucson! You will be tasked with managing medical claims and ensuring accurate billing and collections. This position requires skills in various accounting software systems, knowledge of EHR systems, ideally Nextgen or NetSmart, however, open to sharp candidates who are open to learning new EHR systems.

Responsibilities:

• Handle medical claims with precision and ensure timely processing

• Utilize accounting software systems to maintain accurate records and facilitate collections

• Leverage EHR systems to access patient data and manage billing functions

• Keep a meticulous record of accounts receivable and follow up on pending claims

• Address and resolve any customer inquiries related to billing and collections

• Conduct appeals and authorizations as part of the medical claims process

• Ensure compliance with all billing functions and benefit functions

• Apply knowledge of Dynamic Data Exchange (DDE) in the processing of claims

• Work with NextGen or Netsmart systems for efficient management of claims and billing.

Requirements

• Must possess a minimum of two years of experience in Medical Billing/Claims/Collections.

• Experience with EHR SYSTEM is essential.

• Must have a strong understanding of Accounts Receivable (AR).

• Ability to handle Appeals is expected.

• Expertise in managing Authorizations is necessary.

• Understanding of Benefit Functions is required.

• Proficiency in Billing Functions is essential.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .

**Become a part of our caring community and help us put health first**

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.

The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana’s Bold Goal mission, throughout all activities.

**Use your skills to make an impact**

**Required Qualifications**

+ MD or DO degree

+ 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

+ Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.

+ A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.

+ No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

+ Excellent verbal and written communication skills.

+ Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation) **Preferred Qualifications**

+ **Understands Medicare Inpatient Guidelines**

+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

+ Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

+ Experience with national guidelines such as MCG® or InterQual

+ Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization

+ Advanced degree such as an MBA, MHA, or MPH

+ Exposure to Public Health principles, Population Health, analytics, and use of business metrics.

+ Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

+ The curiosity to learn, the flexibility to adapt and the courage to innovate

+ **Additional Information** Typically reports to a Director of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

+ Satellite, cellular and microwave connection can be used only if approved by leadership

+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

+ This is a remote position\#LI-Remote

**Scheduled Weekly Hours**

40

**Pay Range**

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$199,400 - $274,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

**Description of Benefits**

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

**About us**

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

**Equal Opportunity Employer**

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

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

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

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Specialist Sr - Professional Liability

**PRIMARY PURPOSE** : To analyze complex or technically difficult medical malpractice claims; 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 medical malpractice 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.

+ 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.

**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**

Six (6) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Performs other duties as assigned.

+ 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

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

**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 to $119,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

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

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

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

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

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

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

Environmental Claims Specialist

**Job Description Summary**

To analyze complex or technically difficult environmental claims; 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 environmental liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

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

+ Analyzes applicable complex liability insurance coverage and policies

+ 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 are required. Professional certification as applicable to line of business preferred.

**Experience**

Ten (10) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ In-depth knowledge of appropriate environmental liability insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim duration, cost containment principles 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.**

**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

Environmental Claims Specialist

**Job Description Summary**

To analyze complex or technically difficult environmental claims; 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 environmental liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

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

+ Analyzes applicable complex liability insurance coverage and policies

+ 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 are required. Professional certification as applicable to line of business preferred.

**Experience**

Ten (10) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ In-depth knowledge of appropriate environmental liability insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim duration, cost containment principles 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.**

**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

Environmental Claims Specialist

**Job Description Summary**

To analyze complex or technically difficult environmental claims; 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 environmental liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

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

+ Analyzes applicable complex liability insurance coverage and policies

+ 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 are required. Professional certification as applicable to line of business preferred.

**Experience**

Ten (10) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ In-depth knowledge of appropriate environmental liability insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim duration, cost containment principles 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.**

**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)

Start Date: 1/06/2025

Work Schedule: Monday - Friday (8:00 AM to 5:00 PM)

This job is responsible for resolving the day-to-day complex claims and escalations including in-depth analysis for fraud and non-fraud claims, handling complex decisions based on analytical research, established policies and procedures, and judgment. Key responsibilities include following all applicable regulatory guidelines and establishing procedures while utilizing multiple systems and tools. Job expectations include interacting with multiple business partners and clients in order to educate, set appropriate expectations, or deny the claim.

Responsibilities:

Interacts with multiple business partners to appropriately investigate and decision claim
Follows up with clients either verbally or through written communication
Educates and communicates claim decisions to clients
Records data captured during client interactions accurately
Skills:

Attention to Detail
Decision Making
Due Diligence
Research
Active Listening
Adaptability
Issue Management
Problem Solving
Business Acumen
Collaboration
Oral Communications
Written Communications
Shift:

1st shift (United States of America)
Hours Per Week:

40

We are currently looking for Claims Representatives for a Remote Opportunity.

**You MUST be located within the Phoenix area and have the following qualifications** :

+ **1-2 Years Claims Processing/Reviewing Experience**

+ Strong Computer Skills

+ Works full range of claims, correspondence, quality assurance and escalations.

+ Attention to detail

+ Critical Reasoning Skills

+ Ability to use six different applications/software simultaneously.

+ 1st day is ONSITE and then remote

+ Schedule times may vary from 6a - 10am starts.

+ No absences or tardies for the 2 weeks of training.

+ Submit most recent Resume detailing previous employers, dates and duties

+ Complete Adecco Assessments

Remote/Onsite: AZ Remote

Time Zone Requirements: AZ Local Time

Pay Rate: $18.00

Start Date: 11/11/24

Work Schedule: May Vary

**Pay Details:** $18.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

+ The California Fair Chance Act

+ Los Angeles City Fair Chance Ordinance

+ Los Angeles County Fair Chance Ordinance for Employers

+ San Francisco Fair Chance Ordinance

**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

**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**

$63,700.00 - $105,100.00

**Target Openings**

5

**What Is the Opportunity?**

Travelers' Claim Organization is at the heart of our business by providing assurance to our customers during life's rainy days. As a Property Claim Representative you will walk our customers through home and business claims while evaluating damage and negotiating on their behalf. You will leverage your interpersonal and critical thinking skills to evaluate and resolve personal and business property claims. When a catastrophe happens, you will be first to respond while keeping customers' peace of mind a top priority.

As of the date of this posting, Travelers anticipates that this posting will remain open until November 4, 2024.

**What Will You Do?**

+ Provide quality claim handling throughout the claim life cycle while maintaining full compliance with internal and external standards and state specific regulations. Resolves previously closed 1st party PI and BI Property claims that vary in severity and/or complexity.

+ Resolve inquiries from customers, contractors, agents or other participants on open or closed Property claims.

+ Participate in our Catastrophe Response Program which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states.

+ Complete virtual inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates.

+ Handle claims and other functional work involving one or more lines of business other than property.

+ Acquire and maintain relevant Insurance License(s) to comply with state and Travelers requirements.

+ Perform other duties as assigned.

**What Will Our Ideal Candidate Have?**

+ Interpersonal and customer service skills - Advanced

+ Organizational and time management skills - Intermediate

+ Ability to work independently - intermediate

+ Judgment, analytical and decision making skills - Intermediate

+ Negotiation skills- Intermediate

+ Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively - Intermediate

+ Investigative skills - Intermediate

+ Ability to analyze and determine coverage - Intermediate

+ Analyze, and evaluate damages - Intermediate

+ Resolve claims within settlement authority - Intermediate

+ Bachelor’s Degree.

+ Customer Service experience.

+ Two years of outside property claim handling experience.

+ Excellent interpersonal and customer service skills with the ability to use sound judgement to analyze and resolve claims.

+ Ability to work independently, manage time, and prioritize multiple claims simultaneously.

+ Excellent written and verbal communication skills with the ability to negotiate, convey, and receive information effectively.

**What is a Must Have?**

+ High School Diploma or GED.

+ One year of outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program.

**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/ .

Property Claims Adjuster II - CL09DN

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

Are you a driven and motivated problem solver ready to pursue meaningful work. Do you strive to make an impact every day & not only at work, but in your personal life and community too. If that sounds like you, then you've landed in the right place.

At The Hartford, we respect our employees for their unique perspectives, ideas and solutions. We empower individuals and teams to invent faster, smarter ways of meeting customer needs while improving our performance. Character and customer value are just as vital to our reputation as financial performance which leads to behaviors that put the customer at the center of everything we do.

This position will be accountable for successfully investigating, managing, and settling emergency mitigation, biohazard, asbestos/lead, and mold billing. The ideal candidate will partner with other claims adjusters to resolve this portion of the claim. The candidate will handle all work by ensuring all mitigation work meets quality and compliance standards and adheres to our vendor agreements. Dependent on your home location this role may have a virtual or hybrid in-office work arrangement.

Manage Claim Files:

+ Handle assigned emergency mitigation and mold damages in a manner consistent with corporate claim policies and procedures, and statutory, regulatory and ethics requirements and business unit goals.

+ Manage the emergency mitigation and mold aspects of assigned claims, which includes contact with vendors, manage file to timely resolution, verification of charges, and complete all data integrity components.

+ Utilize organization and communication skills to effectively resolve assignments, manage claim deadlines, and appropriately manage vendors.

+ Develop technical and jurisdictional expertise, including knowledge of independent adjusters, contractors, vendors, etc.

Provide Exceptional Customer Service:

+ Maintain dedication to meeting or exceeding expectations and requirements of internal and external customers.

+ Establish and maintain effective relationships with customers, gaining their trust and respect. Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations.

+ Treat all customers with respect and careful attention.

+ Clearly explain technical information that is helpful to customers.

+ Negotiate skillfully in challenging situations with internal and external groups.

+ Always demonstrate professionalism and establish credibility when interacting with customers; personally enhance The Hartford's reputation in the marketplace.

Utilize Business Acumen and Technical Expertise:

+ Demonstrate knowledge of all relevant terminology to ensure accurate management of the claim.

+ Utilize verbal and numerical critical thinking skills to gather information and data; make sound decisions based upon the mixture of analysis, wisdom, experience and judgment.

+ Ability to communicate orally and in writing in a clear, succinct manner.

+ Ability to utilize computer technology to efficiently perform job functions.

Foster Teamwork and Inclusion:

+ Support and help create a team environment where individual differences are valued.

+ Demonstrate courtesy, honesty, integrity, respect and competence when interacting with others.

+ Build appropriate rapport and constructive and effective relationships with people inside and outside the organization.

+ Represent The Hartford as a credible, trustworthy, flexible and dependable resource.

+ Consistently act with the highest level of integrity and adhere to general principles of business ethics.

What are we looking for?

+ Minimum of 1 year property claim handling experience, including Xactimate estimating experience; 3 years preferred

+ WRT and ASD certification required. AMRT certification preferred

+ Demonstrated high level of performance in current or past roles

+ Xactimate Certification is a plus

+ Proficient in preparing and evaluating structural damage estimates in Xactimate on moderate complexity personal property losses.

+ Critical thinking and problem-solving skills inclusive of investigation, decision making and conflict resolution, with attention to detail.

+ Ability to negotiate for resolution.

+ Ability to coach and mentor peers.

+ Effective time-management skills and the ability to work independently.

+ Ability to create and maintain loyal customers through your actions.

+ Ability to demonstrate active listening skills and exhibit empathy during difficult situations.

+ Ability to communicate clearly and accurately – both verbally and in writing.

+ Ability to adapt to change and to learn and utilize multiple systems to manage claims

+ Computer literacy and strong keyboard skills.

What else can you tell me?

+ You must obtain and maintain a State Adjuster’s License to process Property & Casualty Insurance Claims in the states supported by your department. You will be required to successfully pass the Licensing exam(s) within 30 business days from the completion of the licensing training.

+ This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.

+ For full-time, occasional, part-time or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Wifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$58,000 - $87,000

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories) | Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity) | Benefits (https://www.thehartford.com/careers/benefits)

Human achievement is at the heart of what we do.

We believe that with the right encouragement and support, people are capable of achieving amazing things.

We put our belief into action by ensuring individuals and businesses are well protected, and by going even further – making an impact in ways that go beyond an insurance policy.

Nearly 19,000 employees use their unique talents in careers that span a variety of disciplines – from developing the latest technology to creating and promoting our products to evaluating future financial risks.

We’re also committed to programs that drive education and support volunteerism, which put human beings first. We do it because it’s the right thing to do, and because when our customers, communities and employees succeed, we all do.

About Us (https://www.thehartford.com/about-us)

Culture & Employee Insights

Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity)

Benefits

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