Account Consultant

Sedgwick • Telecommuter OK, OK

3d

About The Position

The Account Consultant manages a caseload of basic to highly complex claims within the granted authority level, 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 such as subrogation, fraud evaluation, and case management review. It investigates, evaluates, and resolves claims; assesses exposure; applies insurance coverage and jurisdictional requirements; and manages litigation in collaboration with clients and legal representatives. The Account Consultant also reviews claim files and strategies, monitors compliance and reporting requirements, supports team tasks and projects, and helps ensure claims are transferred and handled appropriately. The role supports the organization's quality programs and performs other duties as assigned.

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 is preferred.

Responsibilities

• Use special account instructions to obtain individual customer information and follow instructions; 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 in a timely manner.
• 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 recommend corrections; 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 accordance 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 required state documentation accurately and within jurisdictional timeframes and guidelines.
• Monitor assigned reports and document compliance with jurisdictional requirements, including EDI and benefit-payment timeliness.
• Assist the Team Lead in tracking completion of team tasks and projects; review SAS/SOX documents and submit them on time.
• Assist with takeover and reverse takeover projects, ensuring claim files are transferred and handled appropriately.
• Support the organization's quality programs and perform other duties as assigned.

What This Job Offers

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