Claims Adjusters, Examiners, and Investigators

**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 Appeals/Disputes 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.

**Use your skills to make an impact**

**Responsibilities**

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines.

**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).

+ Current and ongoing Board Certification an approved ABMS Medical Specialty

+ A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, 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**

+ 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 specialists

+ Advanced degree such as an MBA, MHA, MPH

+ Exposure to Public Health, 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 Regional Vice President 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. May participate on project teams or organizational committees.

\#physiciancareers

**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.

$223,800 - $313,100 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.

Application Deadline: 05-31-2025

**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

Commercial Auto Bodily Injury Claims Examiner | Remote | Dedicated Client | Complex Claims & Litigation Experience Required

+ **Must have experience with complex bodily injury claims including litigated claims and settlement authority over $1M.**

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

+ **In-depth claims litigation experience to include attending mediations/trials**

+ **Knowledge of risk transfer claims**

+ **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.**

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

+ Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

+ Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

+ Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.

+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.

+ Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

**ARE YOU AN IDEAL CANDIDATE?** To analyze Commercial Auto Bodily Injury claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

**PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**

+ Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

+ Negotiating settlement of claims within designated authority.

+ Communicating claim activity and processing with the claimant and the client.

+ Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

**QUALIFICATIONS**

Education & Licensing: 5 years of commercial auto bodily injury claims experience or equivalent combination of education and experience required.

High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.

Professional certification as applicable to line of business preferred.

**TAKING CARE OF YOU**

+ Flexible work schedule.

+ Referral incentive program.

+ Career development and promotional growth opportunities.

+ A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

**Skills & Knowledge**

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

+ In-depth claims litigation experience to include attending mediations/trials

+ Knowledge of risk transfer claims

+ 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 requirements for entry-level opportunities include:

Physical: Computer keyboarding

Auditory/visual: Hearing, vision and talking

Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

\#claims #claimsexaminer #remote

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 (60,250 - 87,000). 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

Bodily Injury Claims Examiner | Remote | Dedicated Client | Complex Claims & Litigation Experience Required

+ **Must have experience with complex bodily injury claims including litigated claims and settlement authority over $1M.**

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

+ **In-depth claims litigation experience to include attending mediations/trials**

+ **Knowledge of risk transfer claims**

+ **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.**

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

+ Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

+ Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

+ Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.

+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.

+ Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

+ **ARE YOU AN IDEAL CANDIDATE?** To analyze **Commercial Auto Bodily Injury** claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE**

+ Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

+ Negotiating settlement of claims within designated authority.

+ Communicating claim activity and processing with the claimant and the client.

+ Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

+ **QUALIFICATIONS** Education & Licensing: **5 years of commercial auto bodily injury claims experience** or equivalent combination of education and experience required.High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **TAKING CARE OF YOU**

+ Flexible work schedule.

+ Referral incentive program.

+ Career development and promotional growth opportunities.

+ A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

+ **Skills & Knowledge**

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

+ In-depth claims litigation experience to include attending mediations/trials

+ Knowledge of risk transfer claims

+ 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 requirements for entry-level opportunities include:Physical: Computer keyboardingAuditory/visual: Hearing, vision and talkingMental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.\#claims #claimsexaminer #remoteAs 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 (60,250 - 87,000). 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

Claims Examiner - Auto

**Candidates within a 25< mile radius from an office location will be required to go into the office in an agile/hybrid schedule of 2x a week in office.**

**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation 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

_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$75,000- $82,000_** _._ _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.

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)

The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires the knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.

Key Responsibilities:

+ Document all claim information including phone calls and correspondence.

+ Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.

+ Ability to read multiple pages of medical records to confirm benefits available to the member.

+ Ability to apply plan provisions understand the needs of the clients.

+ Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting.

+ Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.

+ Willing to support special internal functional projects and ad hoc requests as required.

+ Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.

+ Able to communicate risks issues to supervisor and help with the resolution, as needed.

+ Provide exceptional customer service either over the phone or through email.

+ Able to provide leadership updates progress reports on training curriculum.

+ Utilize tools independently and accurately to identify work to be completed.

+ Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.

Basic Qualifications:

+ Minimum of 6 months experience in Medical Insurance Claims Processing

+ Minimum of 1 year experience in a contact center/call center.

Preferred Qualifications:

+ Group Life/Disability/ Voluntary Claims experience

+ Bachelor s Degree

+ NY Adjustor License

+ Strong mathematical skills

Professional Skills:

+ Proficiency in Windows environment, including Word and Excel

+ Medical terminology knowledge

+ Strong written and verbal communications required

+ Detailed oriented with strong time management skills

Job Requirement: Schedule flexibility to work a schedule from 7 am to 7 pm CST

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New York or Washington as set forth below.We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here. (https://www.accenture.com/us-en/careers/local/total-rewards)

Role Location Hourly Salary Range

California $19.71 to $31.15

Colorado $19.71 to $26.88

District of Columbia $21.01 to $28.65

Illinois $18.27 to $26.88

Minnesota $19.71 to $26.88

Maryland $18.27 to $24.90

New York $18.27 to $31.15

Washington $21.01 to $28.65

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here (https://www.accenture.com/us-en/about/inclusion-diversity/us-workforce)

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Accenture is committed to providing veteran employment opportunities to our service men and women.

For details, view a copy of the Accenture Equal Employment Opportunity and Affirmative Action Policy Statement (https://www.accenture.com/content/dam/accenture/final/accenture-com/document/Annual-Policy-Statement-Regarding-EEO-2023-Applicant.pdf#zoom=50) .

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email (https://www.accenture.com/us-en/about/contact-us) or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

Description

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

Skills

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

Top Skills Details

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

Additional Skills & Qualifications

Responsibilities and Duties

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

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

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

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

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

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

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

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

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

• Other duties as assigned.

Experience Level

Entry Level

Pay and Benefits

The pay range for this position is $25.00 - $25.00/hr.

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

Workplace Type

This is a fully onsite position in Phoenix,AZ.

Application Deadline

This position is anticipated to close on Mar 26, 2025.

About TEKsystems:

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

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

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 Examiner - Liability

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

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

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

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

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

+ Prepares necessary state fillings within statutory limits.

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

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

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

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

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

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

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

+ Refers cases as appropriate to supervisor and management.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

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

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

_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_ **_$80,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

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

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

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

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

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

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

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

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Examiner - Liability

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

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

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

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

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

+ Prepares necessary state fillings within statutory limits.

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

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

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

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

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

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

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

+ Refers cases as appropriate to supervisor and management.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

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

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

_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_ **_$80,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

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

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

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

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

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

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

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

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Examiner - Liability

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

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

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

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

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

+ Prepares necessary state fillings within statutory limits.

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

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

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

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

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

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

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

+ Refers cases as appropriate to supervisor and management.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

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

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

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

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

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

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

_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_ **_$80,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

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

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)

One Claim Solution is a fast-growing insurance billing company based in Gilbert, AZ. Our contractors are the backbone of America–small, independent businesses that repair homes damaged by floods and fire. These businesses hire OCS to help with insurance claims billing. We use our expertise in working with property casualty insurance companies to help contractors get paid more, faster so they can run their businesses better.

The primary function of the Claims Advocate 1 position is to negotiate and settle claims with insurance adjusters. In this role, you’ll be a key part of a small team to deliver results. Your team will aim to get paid as much as possible, as quickly as possible on claims. OCS pays a generous performance bonus to teams that deliver results on a quarterly basis!

Role & Responsibilities

Primary responsibilities include, but are not limited to:
-Manage a desk of revolving claims and tasks effectively
-Accept incoming calls / emails and make outbound calls / emails each day in an effective manner that moves the claims process forward.
-Follow protocol to oversee the settlement process of assigned claims on behalf of contractors, including researching, problem solving and escalating claims to reach resolution.
-Evaluate offers from adjusters, then provides justification for additional payments or settles for awards based on careful analysis
-Collaborate with team members to determine the optimal path to optimize payment and timeline
-Review claim and invoice documentation, insurance policies and internal protocols and strategies to improve justifications and payment outcomes
-Identify and elevate early settlement opportunities and ensures an overall timely and appropriate settlement
-Build positive relationships by going above and beyond with customer service, ensuring that all questions, cancellations, and confirmations are handled appropriately
-Ensure thorough assessment and attention to detail in keeping accurate records of claims and actions taken, utilizing our CRM and other software.
-Meet daily qualitative and quantitative targets for yourself and your team.

Candidate profile and capabilities

-Eager and curious to learn new things
-Capacity to work and adapt in a growing and changing environment
-Attention to detail with ability to read, absorb and critically evaluate insurance policies
-Professional communication, both written and oral
-Problem solver with a high degree of perseverance and creativity to find solutions
-Self-directed with strong work ethic and ability to manage a high volume of work
-Ability to navigate conflict and de-escalate tension
-Strong negotiation capabilities a plus
-Results orientation with focus on activities that deliver outcomes and meet company, team and individual goals
-Experience and qualifications

-Bachelor’s degree preferred but Highschool Diploma or GED acceptable for candidates looking to learn about and start an exciting new career.