Sr Account Consultant

📋 Description

• • Manages a caseload of highly complex claims involving personal, casualty, or property losses exceeding $1 million, including multi-building claims and discontinuing business expense coverage issues.
• • Applies jurisdictional and medical knowledge to accurately assess indemnity, medical, and expense exposure of assigned claims while interpreting insurance coverage terms and state laws.
• • Utilizes special account instructions to obtain client-specific information and coordinate specialized services such as subrogation, fraud evaluation, and case management reviews to resolve claims efficiently.
• • Investigates, evaluates, and resolves complex claims by identifying potential problems or trends in claim files and implementing corrective actions or recommendations.
• • Proactively manages litigation in alignment with client requirements, working constructively with clients and legal representatives to achieve favorable resolutions.
• • Ensures compliance with all statutory guidelines, licensing requirements, and jurisdictional timeframes to prevent penalties and ensure accurate documentation (e.g., EDI, benefit payment timeliness).
• • Reviews client files and collaborates with team members to analyze claim strategies, status, and emerging trends, preparing comprehensive reports and recommendations.
• • Mentors and coaches account representatives and specialists, facilitating team roundtable discussions to enhance performance and knowledge sharing.
• • Monitors assigned reports and documents compliance with key jurisdictional requirements, assisting Team Leads in tracking team task completion and project deliverables.
• • Reviews and submits SAS/SOX documentation in a timely manner and supports claim file transfers during takeover and reverse takeover projects.
• • Maintains effective relationships with internal colleagues and external customers through clear, timely, and professional communication.
• • Adheres to all organizational quality programs and supports continuous improvement initiatives.
• • Performs other duties as assigned, including travel as required and consistent use of Microsoft Office products and internal claim systems.
• • Demonstrates strong analytical, interpretive, organizational, and problem-solving skills while managing multiple priorities and meeting strict deadlines under work-related stress.