Senior Account Consultant

This is a fully remote position, open to applicants in Texas.

📋 Description

• Oversee a caseload of claims that range from simple to highly intricate, staying within authorized limits.

• Handle the financial aspects associated with the claims assigned to you.

• Follow specific account instructions to gather customer information and comply with directives.

• Recognize, initiate, and coordinate specialized services such as subrogation, fraud assessment, and case management reviews.

• Build and sustain productive relationships with both internal and external customers and colleagues.

• Communicate effectively and in a timely manner.

• Provide mentorship and coaching to account representatives and specialists.

• Lead round table discussions within your designated team.

• Investigate, assess, and resolve claims efficiently.

• Detect potential issues and patterns in claim files, implementing corrective measures or recommendations as necessary.

• Interpret medical documentation and jurisdictional laws relevant to claim management.

• Evaluate indemnity, medical, and expense risks, applying insurance coverage as needed.

• Review client files and collaborate with the team on strategies, claim statuses, and emerging trends.

• Actively manage litigation processes with clients and legal representatives.

• Reduce financial risk while ensuring compliance and achieving optimal outcomes.

• Gather requirements to avoid penalties and fines.

• Monitor reports and ensure adherence to jurisdictional standards, including EDI and timely benefit payments.

• Support the Team Lead in tracking team assignments and projects.

• Timely review and submission of SAS/SOX documentation.

• Aid in takeover and reverse takeover projects, ensuring proper transfer of claim files.

• Perform additional duties as assigned.

• Contribute to the organization’s quality initiatives.

⛳️ Requirements

• State adjuster licenses are mandatory.

• A minimum of six (6) years of relevant experience and/or training or an equivalent combination of education and experience is required.

• A bachelor's degree from an accredited college or university is preferred.

• In-depth legal and jurisdictional knowledge as it pertains to the specific line of business.

• Excellent verbal and written communication skills, including the ability to present effectively.

• Proficient in PC usage, including Microsoft Office applications.

• Strong analytical and interpretive abilities.

• Exceptional organizational skills.

• Outstanding interpersonal abilities.

• Strong customer service orientation.

• Capacity to thrive in a collaborative team environment.

• Ability to meet or exceed established Performance Competencies.

🏝️ Benefits

• Work-life balance.

• Supportive and caring culture.

• Opportunities for career advancement.

• Reasonable accommodations provided when applicable and appropriate.

• Commitment to equal employment opportunities.

• Drug-free workplace.