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Claims Representative - Consumer
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring countsR. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
PRIMARY PURPOSE : To analyze reports claims, determine benefits due and make timely payments and adjustments; to make timely payments and adjustments for specified program claims including high value and complex claims; to coordinate investigative efforts; to thoroughly review contested claims; to negotiate settlement of claims up to the designated authority level; and to provide superior customer services.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Manages first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program.
Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client.
Adjudicates proper settlement up to designated authority level.
Works directly with underwriter/client on high value and complex cases.
Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines.
Performs other duties as assigned.
Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Bachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred. Licenses as required.
Experience
Three (3) years of claims management experience or equivalent combination of experience and education required.
Skills & Knowledge
In-depth knowledge of first party property and casualty claim adjudication as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Excellent analytical and interpretive skills
Excellent organizational 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, is 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 is an Equal Opportunity Employer and a Drug-Free Workplace.
