Account Consultant

Sedgwick Claims Management Services Ltd; Texas; Hybrid; USD 80,000 - 110,000; Full time

Job summary

Sedgwick Claims Management Services Ltd in Texas seeks a seasoned claim professional to manage a caseload from basic to highly complex claims, mentor junior staff, and coordinate subrogation, fraud evaluation or case management when needed.

You will interpret medical reports, apply state and jurisdictional law, monitor client files, document trends, and ensure timely, compliant settlement decisions while maintaining strong relationships with clients and coworkers.

Qualifications

• Bachelor's degree preferred; state adjuster licenses required.
• Six years of related experience and/or training.
• Strong legal/jurisdictional knowledge and communication skills.

Responsibilities

• Manage a claim caseload from basic to highly complex within granted authority.
• Mentor Account Representatives and Account Specialists; coordinate specialized services.
• Investigate, evaluate and resolve claims; monitor trends and ensure timely, compliant outcomes.

Skills

Claim handling

Legal knowledge

Oral communication

Written communication

Analytical skills

Team leadership

Education

Bachelor's degree

State adjuster license

Tools

Microsoft Office

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

PRIMARY PURPOSE

To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications, along with financial implications and to mentor Account Representatives and Account Specialists.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Utilizes special account instructions to obtain individual customer information and adhere to instructions; identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims. Establishes and maintains effective relationship with internal and external customers and coworkers; communicates effectively and timely. Mentors/coaches account representatives and account specialists; facilitates round table discussions within the assigned team. Investigates, evaluates and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations; interprets medical reports and state law or jurisdictional law in claim handling. Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage. Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends. Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve claims. Ensures compliance and best possible outcomes by minimizing financial liability. Compiles requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines. Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned. Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing: Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.

Experience: Six (6) years of related experience and/or training or equivalent combination of education and experience required.

Skills & Knowledge: Thorough legal and jurisdictional knowledge based on line of business. Strong oral and written communication, including presentation skills. PC literate, including Microsoft Office products. Analytical and interpretive skills. Strong organizational skills. Excellent interpersonal skills. Strong customer service skills. Ability to work in a team environment. Ability to meet or exceed Performance Competencies.

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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. 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.

EEO & DIVERSITY STATEMENTS

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. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com