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Account Representative - Workers' Compensation
at Sedgwick CMS in New Jersey
Specialty Risk Services
Account Representative - Workers' Compensation
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 double-digit 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.
ESSENTIAL FUNCTIONS and DUTIES
1.Utilizes Special Account Instructions to obtain individual customer information and adhere to instructions; identifies and initiates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
2.Establishes and maintains effective relationship with internal and external customers and coworkers.
3.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.
4.Applies basic jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
5.Participates in client file review and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
6.Proactively manages litigation in conjunction with client requirements and works constructively with client and legal representatives to resolve claims.
7.Ensures compliance and best possible outcomes by minimizing financial liability.
8.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 timely and accurately in accordance with specific jurisdictional timeframes and guidelines.
ADDITIONAL FUNCTIONS and DUTIES
1.Performs other duties as assigned.
2.Supports the organization’s quality program(s).
3.Travels as required.
QUALIFICATIONS
Education
College degree preferred.
Experience
Three (3) years of related experience required. State adjuster licenses as required.
Skills and Knowledge
-Legal and jurisdictional knowledge on line of business
-Knowledge of medical terminology
-Good oral and written communication skills
-PC literate including Microsoft Office products
-Analytical and interpretive skills
-Problem solving skills
-Good customer service skills
-Good interpersonal skills
-Good organizational 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.
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/19690158
Account Representative - Workers' Compensation
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 double-digit 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.
ESSENTIAL FUNCTIONS and DUTIES
1.Utilizes Special Account Instructions to obtain individual customer information and adhere to instructions; identifies and initiates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
2.Establishes and maintains effective relationship with internal and external customers and coworkers.
3.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.
4.Applies basic jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
5.Participates in client file review and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
6.Proactively manages litigation in conjunction with client requirements and works constructively with client and legal representatives to resolve claims.
7.Ensures compliance and best possible outcomes by minimizing financial liability.
8.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 timely and accurately in accordance with specific jurisdictional timeframes and guidelines.
ADDITIONAL FUNCTIONS and DUTIES
1.Performs other duties as assigned.
2.Supports the organization’s quality program(s).
3.Travels as required.
QUALIFICATIONS
Education
College degree preferred.
Experience
Three (3) years of related experience required. State adjuster licenses as required.
Skills and Knowledge
-Legal and jurisdictional knowledge on line of business
-Knowledge of medical terminology
-Good oral and written communication skills
-PC literate including Microsoft Office products
-Analytical and interpretive skills
-Problem solving skills
-Good customer service skills
-Good interpersonal skills
-Good organizational 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.
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/19690158
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