Claims Representative - Consumer

Sedgwick; Seven Hills (OH); On-site; USD 45,000 - 65,000; Full time

Job summary

Sedgwick in the United States is seeking a Claims Representative - Consumer to analyze reports, determine benefits, and make timely payments and adjustments for a range of consumer claims. You will coordinate investigations, review contested claims, and negotiate settlements within your authority.

The role emphasizes delivering superior customer service, handling high volumes, and collaborating with underwriters and clients while maintaining accurate documentation and adherence to deadlines.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Three years of claims management experience or equivalent combination required.
• Strong knowledge of first party property and casualty claim adjudication.

Responsibilities

• Manages first party property, casualty and/or medical reimbursement claims based on 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.

Skills

Claim adjudication

Communication

PC literacy

Analytical skills

Organization

Interpersonal skills

Teamwork

Performance competencies

Education

Bachelor's degree

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.

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.