Role Description The Senior Associate, Fraud & Complaints, Solar Servicing is responsible for resolving complex cases protecting the Bank from legal, financial, reputational, and operational risk. This role completes thorough investigations into complaints and suspected fraudulent activities, including those involving installer, borrower, sales representative, and first-party and third-party fraud. - Investigate and solve fraud cases using various tools available: LexisNexis, DataTree, Emailage, analytical data, and others. - Investigate, respond to, and resolve routine and high-risk borrower complaints, including Social Media disputes (BBB, Yelp, Facebook). - Resolve FCRA disputes. - Gather and analyze evidence, employing a variety of investigative techniques, such as loan material review, forensic accounting, call listening, data analysis, and interviews, to uncover fraudulent schemes and identify responsible parties. - Perform investigations at the direction of internal and external counsel, and draft first-pass legal responses and recommendations. - Collaborate with internal stakeholders to ensure appropriate actions are taken to detect, address, and prevent future occurrences of identified fraud cases. - Assist in the development and implementation of risk-based prevention strategies and controls to mitigate risks and safeguard company assets. - Stay up to date with emerging fraud trends, industry best practices, and regulatory requirements related to fraud detection and prevention. - Create comprehensive investigative reports, documenting findings, recommendations, and actions taken to address fraud or complaint incidents, as needed. - Assist in the development and implementation of fraud detection tools and systems to enhance the Company's ability to identify potentially fraudulent activities. - Assist with training and aid vendor team supporting fraud and complaint investigations. - Identify and support process enhancements to streamline processes for Fraud & Complaints team. - Execute on special projects. - Perform other duties as assigned. Qualifications - High School Diploma required; Bachelor’s Degree preferred. - Minimum of 3 years of experience within fraud investigation, conducting complex investigations (preferably in a corporate or financial institution setting) required. - Knowledge of lending regulations, and some or all: FCRA, SCRA, Reg Z, UDAAP, BSA/AML, TILA, OFAC required. - Comfortable reviewing loan and financial transaction information. - Proficient with Microsoft Office tools (Outlook, Word, PowerPoint, Excel). - Proficient in LexisNexis, Snowflake, SQL, DataTree, Emailage. - Ability to see patterns, trends, and spot suspicious behavior. - Proficient in utilizing data analysis tools and techniques to identify patterns, anomalies, and trends indicative of fraudulent activities. - Proficient in conducting online investigative research using search engines and open-source intelligence techniques. - Strong knowledge of fraud detection and prevention techniques and a solid understanding of relevant laws, regulations, and industry standards. - Ability to present complex findings and recommendations to technical and non-technical stakeholders. - High ethical standards and integrity, maintaining confidentiality and professionalism throughout investigations. - Bilingual (English / Spanish) preferred, but not required. - Advanced certifications such as Certified Fraud Examiner (CFE) preferred, but not required. - Experience with fraud or complaint handling in the solar industry preferred, but not required. - Experience with fraud detection software and knowledge of relevant technologies. - Excellent verbal, written, and interpersonal communication skills. - Strong organizational skills and attention to detail. - Outstanding problem-solving and time management skills. - Self-motivated, self-directed, and results-oriented. - Adaptable and able to multitask in a fast-paced environment. - Can work independently and within a team; solution-oriented with a collaborative approach. Requirements - Work is primarily conducted in an office setting while certain positions may allow for remote work through the use of technology at management discretion. - Remain in a stationary position for extended periods of time. - Use hands and fingers. - Utilize a computer monitor with visual acuity. - Operate technology or other office machinery such as printers, scanners, etc. - Communicate clearly verbally and/or in writing with others. Benefits - Comprehensive health, dental, and vision plans. - 4 weeks PTO. - 401k + company match. - Metro SmartTrip benefits ($50/mo). - Remote or hybrid work schedules for most positions. - Incentives for purchasing solar panels, electric vehicles, biking to work, etc. - Paid subscriptions to Veterans Compost, Capital Bikeshare, Imperfect Foods reimbursement, and more! - Best Workplaces for Commuters 2023 & 2024 winner. - The Washington Post Top Workplaces 2023, 2024, and 2025 winner. - American Banker Best Banks to Work For 2023 winner.

Role Description The Claims Data Strategy Lead role is responsible for providing senior-level, hands-on leadership across complex healthcare claims data initiatives. This is a highly autonomous individual contributor role with full ownership accountability for identifying problems, driving solutions, and delivering outcomes with minimal oversight. The role requires rapid ramp-up, strong technical judgment, and the ability to translate complex and disparate claims data into scalable, high-performance analytics that directly support product, client, and business objectives. - Own and drive end-to-end solutions across healthcare claims data initiatives, from problem definition through implementation and validation. - Serve as a senior authority on medical, pharmacy, behavioral health, dental, DME, and ancillary claims data, including experience with FACETs, BlueChip, Prime Therapeutics, ESI, and aggregated claims sources. - Design, build, and optimize advanced SQL-based data models, views, and automation frameworks with a focus on performance, scalability, and maintainability. - Develop and maintain complex claim adjustment sequencing and disposition logic, including support for split claims and multiple, disparate source configurations. - Build utilization metrics tied directly to underlying service-level data, including inpatient, outpatient, professional, and behavioral health levels of care. - Apply deep expertise in healthcare transactions and standards, including 837, 834, 820, HL7, and CCDA, to ensure data accuracy and analytical integrity. - Independently assess unfamiliar data environments and rapidly develop a working understanding of new datasets using systematic, repeatable methodologies. - Proactively identify data gaps, risks, and improvement opportunities and drive them to resolution without waiting for direction. - Partner closely with product, analytics, engineering, and leadership teams to ensure claims data assets support broader business and client goals. This role carries clear ownership accountability and is expected to proactively drive work forward rather than operate in a task-by-task or advisory capacity. Given the seniority and scope of the role, the individual is expected to operate with a high degree of independence, requiring minimal day-to-day oversight. Success in this role is defined by the ability to identify problems, propose solutions, and execute through completion. Qualifications - Bachelor’s degree in Computer Science, Information Systems, or related field (or equivalent practical experience) - 7-10 years of experience working with healthcare data, with deep specialization in claims data and analytics - Expert-level proficiency in SQL and advanced query development across large, complex datasets - Extensive experience building and optimizing complex data models, views, and automation frameworks within SQL platforms - Strong understanding of healthcare claims data structures, including medical, pharmacy, behavioral health, and ancillary claims - Demonstrated ability to develop and maintain complex claim adjustment sequencing and disposition logic - Proven ability to independently assess unfamiliar data environments and rapidly develop working solutions - Strong analytical, problem-solving, and critical-thinking skills - Excellent communication and collaboration abilities across technical and non-technical stakeholders - Ability to work independently, take full ownership of initiatives, and manage multiple priorities with minimal oversight Preferred Qualifications - Experience working with FACETs, BlueChip, Prime Therapeutics, ESI, or aggregated healthcare claims sources - Hands-on experience with healthcare transactions and standards including 837, 834, 820, HL7, and CCDA - Experience developing utilization metrics tied to service-level claims data (inpatient, outpatient, professional, behavioral health) - Strong understanding of performance tuning, query optimization, and scalability considerations in large data environments - Experience supporting analytics, product, or client-facing use cases in healthcare or payment integrity contexts - Background in building reusable, table-driven logic and automation frameworks Company Description SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce the wasteful spend in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

Description Join our team this June 2026! Liberty Mutual’s Personal Lines Casualty team is hiring experienced Claims Specialist to manage attorney‑represented and litigated auto and homeowner bodily injury claims. If you have strong litigation experience, sound judgment, and a commitment to excellent customer service, we want to hear from you. Advance your career with a supportive team and meaningful work that makes a difference. Apply today! Responsibilities: - Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels. - Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation. - Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. - Confers with trial counsel and prepares trial reports. - Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. - Responds to various written and telephone inquiries including status reports. - Ensures adequacy of reserves. - Recommends reserve increases on cases in excess of authority. - Accountable for security of financial processing of claims, as well as security information contained in claims files. - Updates files and provides comprehensive reports as required. - Responsible for managing the practices and billing activities of outside and in-house counsel. - Expected 10% travel for trials, mediations, and in-person events. Preferred Experience: - 2+ years of First Party Claims handling. - 2+ years of Personal Lines Third Party Auto Casualty experience. - 2+ years of Litigation experience. This is a fully remote opportunity for candidates who live more than 50 miles from our claims offices. Candidates who reside within a 50 mile radius will go into the office 2 times per month. The following states are excluded from eligibility: California, Idaho and Washington. Qualifications - Strong written and oral communications skills required. - Strong interpersonal, analytical, negotiation and investigative skills required. - Customer service experience preferred. - Strong competency of legal liability, general insurance policy coverage and State Tort Law. - The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 3 years of directly related experience. - Ability to obtain proper licensing as required. About UsPay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.   We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits    Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.    Fair Chance Notices  - California - Los Angeles Incorporated - Los Angeles Unincorporated - Philadelphia - San Francisco

Title: Claims Associate - Workers Compensation Location: Cincinnati United States Job Description: 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 Claims Associate - Workers Compensation This position offers a hybrid work schedule, with 2 days per week in our Blue Ash office. and the remainder remote. PRIMARY PURPOSE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. - Supports other claims representatives, examiners and leads with larger or more complex claims as necessary. - Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. - Communicates claim action/processing with claimant, client and appropriate medical contact. - Ensures claim files are properly documented and claims coding is correct. - May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims. - Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). QUALIFICATION Education & Licensing High school diploma or GED required. Licenses as required. Experience One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred. Skills & Knowledge - Excellent oral and written communication skills - PC literate, including Microsoft Office products - Analytical and interpretive skills - Strong organizational skills - Good interpersonal skills - Ability to work in a team environment - Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. TAKING CARE OF YOU BY - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. 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 $18.00 - $23.00/HR. 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.