Account Consultant

Sedgwick • Telecommuter FL, FL

3d

About The Position

The Account Consultant manages a caseload of basic to highly complex claims within granted authority, including related financial implications, and mentors Account Representatives and Account Specialists. The role uses special account instructions to obtain customer information, coordinates specialized services, investigates and resolves claims, evaluates exposure and insurance coverage, and works with clients, coworkers, and legal representatives to achieve appropriate outcomes. It also supports compliance with jurisdictional requirements, reporting, team tasks, and claim-file transfers.

Requirements

• Six years of related experience and/or training, or an equivalent combination of education and experience.
• State adjuster licenses are required.
• Thorough legal and jurisdictional knowledge based on the line of business.
• Strong oral and written communication skills, including presentation skills.
• Computer literacy, 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.

Nice To Haves

• Bachelor's degree from an accredited college or university.

Responsibilities

• Use special account instructions to obtain individual customer information and comply with account requirements.
• Identify, initiate, and coordinate specialized services such as subrogation, fraud evaluation, and case management review.
• Establish and maintain effective relationships with internal and external customers and coworkers, communicating effectively and promptly.
• Mentor and coach Account Representatives and Account Specialists, and facilitate team round-table discussions.
• Investigate, evaluate, and resolve claims; identify potential file problems or trends and take corrective action or recommend corrections.
• Interpret medical reports and applicable state or jurisdictional law in claim handling.
• Assess indemnity, medical, and expense exposure using jurisdictional and medical knowledge, and interpret and apply insurance coverage.
• Review client files and collaborate with the team to prepare thorough analyses of file strategies, claim status, and emerging trends.
• Manage litigation proactively in accordance with client requirements and work constructively with clients and legal representatives to resolve claims.
• Minimize financial liability while ensuring compliance and the best possible outcomes.
• Compile requirements to prevent penalties and fines, and ensure state-required documentation is issued accurately and on time under applicable jurisdictional guidelines.
• Monitor assigned reports and document compliance with jurisdictional requirements, including EDI and benefit-payment timeliness.
• Assist the Team Lead in tracking team tasks and projects; review and submit SAS/SOX documents on time.
• Assist with takeover and reverse-takeover projects to ensure claim files are transferred and handled appropriately.
• Perform other duties as assigned and support the organization's quality programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed