Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.Great Place to Work®Most Loved Workplace®Forbes Best-in-State EmployerConsumer Claims RepresentativePRIMARY 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
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
QUALIFICATIONSEducation & LicensingBachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred.ExperienceThree (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 ENVIRONMENTWhen 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 deadlinesPhysical : Computer keyboarding, travel as requiredAuditory/Visual : Hearing, vision and talkingNOTE : 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.If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! 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.