By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Liability (REMOTE - Heavy GL, Lit & BI exp) 10 years complex litigation & BI experience. General Liability Experience required with Premises, Products and Completed operations, and Public Entity would be preferred but not required. NY Adjusters license needed or will be required within 90 days of employment. 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 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? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. - Assesses liability and resolves claims within evaluation. - Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. - Manages subrogation of claims and negotiates settlements. - Communicates claim action with claimant and client. - Ensures claim files are properly documented and claims coding is correct. - May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. - Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience: 4 years of Liability claims management experience or equivalent combination of education and experience required. 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. 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.

"NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment"

Extraordinary Careers. Endless Possibilities. With the nation’s largest home infusion provider, there is no limit to the growth of your career. Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members. Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare. Job Description Summary: This position is responsible for overseeing and executing the reauthorization process for therapies, ensuring that all necessary reauthorization steps are completed in a timely manner. The individual in this position must consistently meet performance targets related to speed and accuracy while maintaining a high level of professionalism and attention to detail in all reauthorization tasks.Job Description: ​ Job Responsibilities - Processes reauthorization with speed and accuracy. - Manages the documentation, communication, and follow-up with relevant plans, referral sources, Pharmacies, and patients. - Assist Reauthorization Supervisor and Manager with special assignments as needed. Supervisory Responsibilities Does this position have supervisory responsibilities? NO (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) Basic Education and/or Experience Requirements - High school diploma or equivalent is required. - Minimum of two years of experience in related experience. Basic Qualifications - Ability to multi-task and support numerous referrals/priorities at one time. - Ability to work in a fast past environment. - High degree of self-discipline in maintaining productivity expectations. - Must be detail-oriented and have a high degree of quality focus. Travel Requirements Not Applicable Preferred Qualifications & Interests Healthcare/medical billing experience preferred. May perform other duties as assigned Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $17.02-$28.38 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -myFlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information. ​

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. A Brief Overview Supports cost management programs to reduce medical claim expense and identify and recover medical claim expense dollars from liable parties. Gathers data and compiles cost analyses to identify cost-saving opportunities and cost reduction strategies to achieve financial goals. What you will do - Performs reviews and processing of claims to insurance carriers for payment to ensure accurate and timely claim submissions, helping patients receive the care they deserve. - Maintains, enters, and organizes all claims reporting, communications, and discovery on claims in the claims drive or a claims administrative system to ensure industry-proven best practices are instilled within the company's strategies and end product offerings. - Conducts analysis and conflict resolution to identify any errors or inconsistencies on initial claims submissions, ensuring claims are error-free and promptly resolved. - Handles correspondence, claims, and referrals in the established timeframes and performance guarantees to ensure a high level of customer satisfaction and loyalty. - Drafts first notice of claims, preservation of evidence letters, and email holds for litigation holds. - Provides communication to and from Operations and other support departments for escalation of service-impacting issues. - Prepares presentations and proposals to internal and external clients to successfully enhance the company's brand recognition and competitive advantage in the industry. - Evaluates methods/processes after listening to customers and gathering feedback to proactively address and resolve customer service requests and issues. - Presents status updates, issues and risks, and solutions to senior management, stakeholders, and partners to drive decision-making and actions. For this role you will need Minimum Requirements - 2-5 years work experience - Adept at problem solving and decision making skills Promptly review, analyze and provide accurate claim information in order to optimize savings on appropriate claims Review claims and apply the correct pricing to the claim review Apply the appropriate contractual and plan benefits to claims reviewed Determines coverage, verifies eligibility, order of benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring correct claim adjudication Required Qualifications 2+ years claim ACAS Medical claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications Excel experience Education High School Diploma or G.E.D. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $38.82 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/20/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.