Utilization review nurse Jobs in Fort Worth, TX

Estimate Review Consultant

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance.

Primary Purpose : To review all estimates and supporting documentation submitted by contractors / adjusters using various estimating applications ensuring estimates follow client and regulatory requirements and meet Property Repair Solutions' guidelines; to serve as a subject matter expert on property restoration scope; to be a client liaison responsible for issue resolution, complex assignments, and auditing.

Essential Functions and Responsibilities :

• Conducts quality reviews of contractor documentation for repair estimates to ensure it meets local area codes, industry and manufacturer requirements, and the guidelines of the carrier and Property Repair Solutions.
• Negotiates with adjusters, contractors, and others as necessary to reach agreement on final scope.
• Creates, reviews, and submits fair and accurate estimates through various platforms including, but not limited to, supporting items to meet safety and / or other local / state / federal agency requirements, type and content of supporting documentation for accounts receivable, and scope differences.
• Records data for initial estimates reviewed, number of reviews, and rejections on all files.
• Identifies any differences and validates whether any differences are justified in accordance with standard industry practices or code.
• Reviews justifications using independent judgment and discretion.
• Aides contractors regarding handling specific types of repairs.
• Receives and responds to questions from contractors or carriers.
• Provides input for the establishment and update of storm guidelines.
• Determines if emergency repairs are appropriate for completion (meet technical requirements for temporary repairs) and authorizes contractors to perform the justified services.
• Monitors, assists, tracks, and provides approval for all claims that are re-inspected by the carrier.
• Maintains contact with the client regarding assignments promoting a professional client relationship.
• Performs quality review audits for compliance with audit requirements, service contract requirements, and quality standards.
• Provides technical direction to other estimate review specialists on complex assignments.
• Handles disputes and issue resolution with clients and contractors.
• Acts as a mentor to less experienced estimate review colleagues.

Additional Functions and Responsibilities :

Qualifications :

Education & Licensing : Bachelor's degree in building construction from an accredited college or university preferred.

Experience : Six (6) years of experience in insurance adjusting or construction background or equivalent combination of education and experience required. Experience using Xactimate estimating software preferred.

Skills & Knowledge :

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 : Must be able to stand and / or walk for long periods of time. Must be able to kneel, squat or bend. Must be able to work outdoors in hot and / or cold weather conditions. Have the ability to climb, crawl, stoop, kneel, reaching / working overhead. Be able to lift / carry up to 50 pounds. Be able to push / pull up to 100 pounds. Be able to drive up to 4 hours per day. Must have continual use of manual dexterity.

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.