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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing and processing medical claims, negotiating settlements, and communicating effectively with clients and claimants. Possesses strong judgment and problem-solving skills to manage multiple priorities and meet deadlines in a fast-paced environment.
Highest-signal resume keywords
Claims Management ExperienceMulti-State Jurisdiction KnowledgeNegotiation SkillsAnalytical SkillsProfessional Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisClaims ProcessingInvestigative SkillsSettlement NegotiationReporting ClaimsComputer Keyboarding
Soft Skills
Clear ThinkingExcellent JudgmentProblem-SolvingDiscretionAbility to Handle Stress
Certifications & Qualifications
Professional Certification
Industry Keywords
Medical ClaimsAdjudicationClient Service RequirementsClaim ExposureExcess Carrier Reporting
About the role
Key responsibilities & impact- Analyze Medical Only claims on behalf of clients to determine benefits due
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
- Analyze and process claims through action plans to timely and appropriate resolution
- Investigate and gather information to determine claim exposure
- Negotiate claim settlements within designated authority
- Communicate claim activity and processing with claimants and clients
- Report claims to the excess carrier
- Respond to requests for directions professionally and timely
Requirements
What you’ll need- High School Diploma or GED required
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- 2 years of claims management experience or equivalent combination of education and experience required
- Multi-state jurisdiction knowledge
- Home-state licensing required
- Ability to analyze and process claims
- Ability to investigate and gather information to determine claim exposure
- Ability to negotiate claim settlements within designated authority
- Ability to communicate claim activity and processing with claimants and clients
- Ability to report claims to excess carriers and respond to requests for directions professionally and timely
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem-solving, analysis, and discretion
- Ability to handle work-related stress and multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding ability
- Ability to travel as required
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Opportunity to work in an agile environment
- Career development and promotional growth opportunities
- Medical, dental, and vision benefits
- 401(k) and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Hybrid schedule for candidates within 25 miles of a Sedgwick office (2 days in office, 3 days from home)
- Fully remote/work-from-home arrangement may be considered for candidates outside the 25-mile radius