Sedgwick’s contact center teams around the world assist clients and consumers with various types of claims including workers’ compensation, liability, property, disability and leave of absence. Our service center representatives are armed with great technical and insurance knowledge, and are ready to answer questions from first notification of loss to final resolution, simplifying the process, reducing complexity and making it easy and effective for everyone involved.
Compliance with regulatory and policy change is an essential part of any successful claims administration program. Our approach to compliance is twofold. Sedgwick educates colleagues and clients to keep them on top of changes and to ensure consistency with industry best practices. And behind the scenes, our integrated technology solutions incorporate legal and policy requirements into the daily claims and case management workflow, making it easy to support clients’ programs.
The breadth of our integrated solution means that clients can get the services they need throughout the lifecycle of a claim in a single package, delivered with the highest customer service levels in the industry. Our flexible model provides a data-driven, clinically focused method for clients with options to help them manage key medical costs. It includes a national provider benchmarking program, integration of health and wellness data, referrals during the claim process, and a national approach to utilization review and clinical management.
Sedgwick’s managed care services offer multi-disciplinary resources, which include clinical consultation, medical bill review, telephonic and field case management, behavioral health and return to work services, complex pharmacy management and utilization review. A range of review and support solutions are also available, such as provider benchmarking and access to medical and specialty networks. We focus on what is medically the best option for the injured employee and what is going to produce the best overall result. We provide a carefully crafted strategy designed to ensure clients are getting the most value for their dollar at the claim level and the most efficient process at the examiner’s desk.
A catastrophic injury is a life-changing moment for an injured employee and time is of the essence. Our complex claims unit engages with our claims management team to streamline the process and deliver a positive experience for all stakeholders. Sedgwick’s experts help severely injured employees recover and return to productive lives by engaging the right resources early in the process, delivering the optimal pathway to a healthy outcome. Identifying at-risk claims, including those that are initially complex and those that appear benign but have the indicators of becoming complex due to comorbidities, psychosocial issues or opioid usage, and applying the appropriate resources early in the life of the claim can positively change the path of recovery for the employee.
Research shows that employees recover faster and more fully from injury and illness when they feel connected to their workplace and their greater community. Sedgwick is committed to maintaining communication while employees are away from work and exploring creative, practical ways to return them to productivity. Our team includes return to work specialists who monitor progress and partner with employees and employers to identify and facilitate options for a safe and healthy return to work. We encourage employers to consider opportunities for transitional, light or modified duty. We help navigate the interactive process and determine appropriate workplace accommodations, remaining mindful of compliance requirements.
Sedgwick is finding new ways to integrate health and productivity management tools along the spectrum, bridging benefit models through innovations in health advocacy. Through our whole health model, Sedgwick is the first to integrate and simplify administration of health, workers’ compensation, disability and leave benefits, linking data and resources through a single point of contact to help promote physical, emotional and financial well-being in the workforce. The whole health solution connects Sedgwick’s expertise in workers’ compensation and disability with the high-touch, high-tech healthcare solution offered by Accolade.
It’s often difficult for employees to understand all of the programs and health-related benefits their employer offers — and who to call for what. An employee’s own health issues, as well as the medical needs of their family, can impact productivity. Within this program, each plan member is assigned a health assistant, who will work with the whole health team to help the employee get the best care possible, navigate complex insurance and benefits, receive the financial assistance to which they are entitled and quickly return to their normal, productive lives.
Reducing loss frequency and severity, lowering the cost of risk and ensuring safety compliance are key goals for clients, but accomplishing them can be difficult while managing complex regulations and other industry challenges. We offer a wide range of expert risk services to help businesses control costs and achieve their objectives. Our experienced team provides tailored solutions to help clients with loss control, safety, ergonomics and OSHA recordkeeping. We offer flexible programs designed to work for employers – from single location corporations and public entities, to associations, groups and captives. And we work closely with insurance carriers to create the best solutions for clients.
We recognize that the identification, investigation and pursuit of fraudulent claims or fraudulent elements of claims are an integral part of claims administration, a critical part of our clients’ risk strategy and an ongoing statutory obligation. Our fraud prevention program combines specific claim techniques and formalized special investigation units (SIU) designed to support fraud mitigation. These units in various regions around the world support employers and claim teams using the latest fraud detection techniques and technology, varied interventions for identified fraud and consultative advice on pursuing fraud in individual circumstances.
Through Vale Training, a Sedgwick company, we have over 60 years' experience offering training to U.S. professionals in insurance, auto repair, construction, green risk and claims at every stage of their career.
We are committed to delivering excellence. Sedgwick’s approach to quality takes the assessment of claims management performance far beyond meeting basic industry compliance requirements by concentrating on program performance, service and outcomes as well as conventional compliance principles. By capturing quality metrics in real time at multiple checkpoints throughout the process, we can provide feedback on individual claims and investigations to prompt better outcomes now; through extensive training for our colleagues and a rigorous feedback and improvement cycle, we also coach toward improved future performance.
Our nationwide team of audit professionals has the experience to handle everything from program business to carrier business including multi-state, multi-class and multi-coverage audits. We consistently deliver accurate, reliable and timely premium audit results, and we offer sophisticated services that can be customized to meet your specific needs and any state requirements.