Claims Representative - Consumer

Sedgwick Claims Management Services Ltd; Seven Hills (OH); On-site; USD 42,000 - 60,000; Full time

Job summary

Sedgwick is seeking a Claims Representative - Consumer to analyze reports, determine benefits, and process timely payments for health, property and casualty consumer claims in Ohio.

The role requires strong communication and analytical skills to support high-quality customer service and proper claim adjudication. A bachelor’s degree and relevant experience are preferred.

Qualifications

• Bachelor's degree preferred.
• Three (3) years of claims management experience or equivalent combination of experience and education.
• Excellent oral and written communication skills; strong analytical abilities.

Responsibilities

• Analyzes first-party property, casualty and/or medical reimbursement claims and determines benefits.
• Makes coverage determinations based on investigation and communicates actions to claimant and client.
• Adjudicates settlements up to designated authority level.
• Collaborates with underwriter/client on high value and complex cases.
• Handles high volume of claims, calls, and correspondence with proper documentation and deadlines.

Skills

Communication

Analytical skills

Team player

Problem solving

Detail-oriented

Education

Bachelor's degree preferred

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 Claims Representative - Consumer

PRIMARY PURPOSE:

• To analyze reports claims, determine benefits due and make timely payments and adjustments; to make timely payments and adjustments for specified program claims including high value and complex claims; to coordinate investigative efforts; to thoroughly review contested claims; to negotiate settlement of claims up to the designated authority level; and to provide superior customer services.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Manages first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program.
• Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client.
• Adjudicates proper settlement up to designated authority level.
• Works directly with underwriter/client on high value and complex cases.
• Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES:

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

QUALIFICATIONS

• Education & Licensing: Bachelor's degree from and accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Experience: Three (3) years of claims management experience or equivalent combination of experience and education required.

Skills & Knowledge

• In-depth knowledge of first party property and casualty claim adjudication as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Excellent analytical and interpretive skills
• Excellent organizational skills
• Excellent 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. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, 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.

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