Sr Account Consultant - Sedgwick Claims Management Services, Inc.

PRIMARY PURPOSE: To manage claim caseload of highly complex claims, coverage issues (handling claims against insurance or other companies related to personal, casualty, or property loss of at least $1million) and complex litigation within granted authority level including related financial implications, along with financial implications and to mentor other team members.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages claim caseloads involving complex coverage issues with specific loss such as discontinuing business expense.
• Handles claims of at least one million dollars and that involve multiple buildings.
• 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 internal colleagues; 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 complex litigated 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.

ADDITIONAL 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
Eight (8) 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

NOTE: Credit security clearance, confirmed via a background credit check, may be required for this position.

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.