Account Consultant

Sedgwick Claims Management Services Ltd; United States; A distancia; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

Sedgwick Claims Management Services Ltd in the United States seeks an Account Consultant to manage a caseload of basic to highly complex claims within granted authority. You will mentor Account Representatives and Account Specialists while coordinating services and ensuring timely, accurate handling.

Responsibilities include evaluating claims, interpreting medical and jurisdictional requirements, managing litigation with clients, and maintaining quality and compliance across the team.

Formación

• Education & Licensing Bachelor's degree from an accredited college or university preferred.
• State adjuster licenses required.
• Six (6) years of related experience and/or training or equivalent combination of education and experience required.
• 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

Responsabilidades

• To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications.
• Mentor Account Representatives and Account Specialists.
• Identifies, initiates, and coordinates various specialized services such as subrogation or case management review to resolve claims.
• Establishes and maintains effective relationship with internal and external customers and coworkers.
• Investigates, evaluates and resolves claims.
• Interprets medical reports and state or jurisdictional law in claim handling.

Conocimientos

Oral and written communication

Analytical skills

Organizational skills

Interpersonal skills

Customer service

Teamwork

Deadline-oriented

Educación

Bachelor's degree

State adjuster licenses required

Herramientas

Microsoft Office

Descripción del empleo

Account Consultant

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
• 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.
• 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

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

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