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Account Consultant at Sedgwick Claims Management Services, Inc

Account Consultant

Sedgwick Claims Management Services, Inc Orlando, FL Full-Time
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Account Consultant

 

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

Sedgwick is a global leader in property insurance claims, offering solutions for commercial and residential markets. We specialize in large/complex losses, large domestic and international commercial risks, middle market commercial property losses, and real estate and catastrophic losses.

  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 and 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.
  • Complies with all statutory guidelines and individual licensing 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.

ESSENTIAL 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 or equivalent combination of experience and education 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
  • Strong Customer Service 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

 

Recommended skills

Subrogation
Written Communication
Insurance
Complex Problem Solving
Instructions
Claims
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Job ID: 133455772

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