Job Details

Overview

By joining Sedgwick, you'll be part of something truly meaningful. Its what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here,theres no limit to what you can achieve.

Newsweek Recognizes Sedgwick as Americas Greatest Workplaces National Top Companies

Certified as a Great Place to Work

Fortune Best Workplaces in Financial Services & Insurance

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($66,000 - $86,000 USD annually). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Primary Purpose

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/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.

• Compiles 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 teams 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 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 and/or training or equivalent combination of education and experience 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

• Excellent interpersonal skills

• Strong customer service 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 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.

For jurisdictions requiring pay transparency, the range of starting pay is provided as applicable. Actual compensation is influenced by skill set, experience, location, and other factors. This posting notes the specific range where applicable.