Account Consultant

Sedgwick•Telecommuter TX, TX

About The Position

The Account Consultant manages a caseload of basic to highly complex claims within their granted authority, including related financial implications, and mentors Account Representatives and Account Specialists. The role uses special account instructions to obtain customer information and coordinate specialized services, investigates and resolves claims, assesses exposure, interprets coverage and jurisdictional requirements, and works with clients, legal representatives, and internal teams to achieve appropriate outcomes. The consultant also monitors compliance, supports team projects, and contributes to the organization’s quality programs.

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 line of business.
Strong oral and written communication skills, including presentation skills.
PC 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 preferred.

Responsibilities

Use special account instructions to obtain customer information and follow account requirements; identify, initiate, and coordinate specialized services such as subrogation, fraud evaluation, or 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 problems or trends in claim files and take corrective action or make recommendations; interpret medical reports and applicable state or jurisdictional law.
Apply jurisdictional and medical knowledge to assess indemnity, medical, and expense exposure and interpret and apply insurance coverage appropriately.
Review client files and collaborate with the team to prepare thorough analyses of file strategies, claim status, and emerging trends.
Proactively manage litigation in conjunction with client requirements and work constructively with clients and legal representatives to resolve claims.
Ensure compliance and favorable outcomes while minimizing financial liability.
Compile requirements to prevent penalties and fines; use provided instructions and tools to issue state-required documentation accurately and within applicable jurisdictional timeframes and guidelines.
Monitor assigned reports and document compliance with key 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.