Senior Claims Consultant & Team Mentor

Sedgwick; Texas; Hybrid; USD 70,000 - 95,000; Full time

Job summary

Sedgwick is seeking an Account Consultant to manage a claim caseload from basic to highly complex within granted authority, coordinating with clients and internal teams.

You will mentor Account Representatives and Account Specialists, discuss medical and legal interpretations with accuracy, and strive for efficient, fair outcomes.

This role emphasizes strong communication, adherence to jurisdictional requirements, and minimizing financial exposure while delivering excellent service.

Qualifications

• Bachelor's degree preferred; state adjuster licenses required.
• 6 years of related experience and/or training or equivalent combination of education and experience.
• Strong legal and jurisdictional knowledge based on line of business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.

Responsibilities

• Manages claim caseload of basic to highly complex claims within granted authority; relates financial implications.
• Identifies, initiates, and coordinates specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
• Mentors/coaches account representatives and account specialists; facilitates round table discussions within the assigned team.
• Investigates, evaluates and resolves claims; interprets medical reports and state law or jurisdictional law in claim handling.
• Applies jurisdictional and medical knowledge to assess indemnity, medical and expense exposure and ensure proper coverage interpretation.
• Reviews client files and collaborates with team to prepare information including thorough analysis of file strategies and trends.
• Proactively manages litigation in conjunction with client requirements; works with client and legal representatives.
• Ensures compliance and minimizes financial liability; compiles requirements to prevent penalties and to ensure timely documentation.
• Monitors reports and documents compliance with jurisdictional requirements; assists with project takeovers ensuring proper transfer of claim files.

Skills

Oral and written communication

Analytical skills

Customer service skills

Team collaboration

Education

Bachelor's degree

State adjuster license

Job description

Sedgwick is seeking an Account Consultant to manage a claim caseload from basic to highly complex within granted authority, coordinating with clients and internal teams.

You will mentor Account Representatives and Account Specialists, discuss medical and legal interpretations with accuracy, and strive for efficient, fair outcomes.

This role emphasizes strong communication, adherence to jurisdictional requirements, and minimizing financial exposure while delivering excellent service.