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Account Consultant - Workers' Compensation
at Sedgwick CMS in California
Specialty Risk Services
Account Consultant
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Specialty Risk Services, (SRS) is a division of Sedgwick Claims Management Services, Inc. (Sedgwick CMS) and is recognized as one of the top third-party claim administrators and risk management services providers in North America. SRS is a fast-paced, dynamic organization providing a wide variety of comprehensive claim and risk management services to medium and large corporations throughout the United States and Canada including 47 Fortune 500 companies.
We value providing exceptional customer service and superior claim handling, while providing our employees with the opportunity for growth and advancement. Continuing revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
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 DUTIES
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 and works constructively with client and legal representatives to resolve 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 Leader in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits to Team Leader in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.
ADDITIONAL FUNCTIONS and DUTIES
Performs other duties as assigned.
Supports the organization’s quality program(s).
QUALIFICATIONS
Education
College degree preferred. State adjuster licenses required.
Experience
Five (5) years related experience required.
Skills and Knowledge
Thorough legal and jurisdictional knowledge based on line of business
Excellent knowledge of medical terminology
Strong oral and written communication skills
PC literate including Microsoft Office products
Good analytical and interpretive skills
Strong problem solving, critical thinking and decision making skills
Strong customer service skills
Strong interpersonal and leadership skills
Excellent time management and organization skills
Leadership skills
Ability to work independently and in a team environment
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.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar: http://sedgwickcms.contacthr.com/19431679
Account Consultant
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Specialty Risk Services, (SRS) is a division of Sedgwick Claims Management Services, Inc. (Sedgwick CMS) and is recognized as one of the top third-party claim administrators and risk management services providers in North America. SRS is a fast-paced, dynamic organization providing a wide variety of comprehensive claim and risk management services to medium and large corporations throughout the United States and Canada including 47 Fortune 500 companies.
We value providing exceptional customer service and superior claim handling, while providing our employees with the opportunity for growth and advancement. Continuing revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
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 DUTIES
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 and works constructively with client and legal representatives to resolve 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 Leader in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits to Team Leader in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.
ADDITIONAL FUNCTIONS and DUTIES
Performs other duties as assigned.
Supports the organization’s quality program(s).
QUALIFICATIONS
Education
College degree preferred. State adjuster licenses required.
Experience
Five (5) years related experience required.
Skills and Knowledge
Thorough legal and jurisdictional knowledge based on line of business
Excellent knowledge of medical terminology
Strong oral and written communication skills
PC literate including Microsoft Office products
Good analytical and interpretive skills
Strong problem solving, critical thinking and decision making skills
Strong customer service skills
Strong interpersonal and leadership skills
Excellent time management and organization skills
Leadership skills
Ability to work independently and in a team environment
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.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar: http://sedgwickcms.contacthr.com/19431679
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