Consumer Care Advocate

Sedgwick Claims Management Services Ltd; Texas; Hybrid; USD 2,066,000 - 2,617,000; Full time

Benefits offered by this job

Comprehensive training program

Benefits package (medical, dental, and

401k and PTO

Job summary

Sedgwick Claims Management Services Ltd is hiring a Consumer Care Advocate in a hybrid role in the United States. You will provide high-quality service to internal and external customers, resolving routine claims questions and guiding clients through processes.

Responsibilities include data entry, claims status updates, referrals to legal and medical review teams, and collaboration with cross-functional teams to ensure accurate documentation and timely resolutions.

Qualifications

• High school diploma or GED required. Associate’s degree preferred.
• Excellent oral and written communication skills.
• PC literate, including Microsoft Office products.
• Strong investigation and organizational skills.

Responsibilities

• Handle incoming calls, faxes and voicemails from claimants, providers, clients and attorneys.
• Communicate claims status and activity to clients and medical contacts.
• Enter data into claims systems and ensure proper documentation and coding.
• Coordinate address updates and referrals to legal, SIU, and other units as needed.
• Support quality programs and perform other duties as assigned.

Skills

Communication skills

PC literacy

Team player

Problem solving

Education

High school diploma

Associate degree preferred

Tools

Microsoft Office

Job description

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 Consumer Care Advocate Consumer Care Advocate Build Your Future with a Team That Wins Together! At Sedgwick, you're more than an employee, you're part of a team that supports, empowers, and celebrates your success every step of the way.

Why You'll Love Working Here:

• A Career Built on Stability Enjoy a dependable work environment with both in-office and virtual opportunities.
• A comprehensive training program Start strong with comprehensive training designed to help you confidently support employees and customers from some of the world's most recognized brands.
• Personalized Support & Coaching Receive guidance from dedicated leaders and mentors who are invested in your growth and success.
• Endless Opportunities to Grow Take your career to the next level with ongoing development, new challenges, and opportunities for advancement.
• Benefits That Put You First Our inclusive benefits package is designed to support your physical, mental, financial, and professional well-being.

Join a team where your contributions matter, your growth is encouraged, and your future is full of possibilities. Your next big opportunity starts here—are you ready to join us? See what a day in the life of a Consumer Care Advocate is like: SED23026 - Mariah_01-09-24 (vidyard.com) & https://share.vidyard.com/watch/VCLjdFEUwPccjWaBtjLmwX Learn more about our Consumer Care Advocate: Care Team (ceros.com)

PRIMARY PURPOSE:

To provide high quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies. Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues. Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct. Coordinates claimant address updates or changes with internal departments. Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned. Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

High school diploma or GED required. Associate’s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required.

Skills & Knowledge

Excellent oral and written communication skills. PC literate, including Microsoft Office products. Strong investigation and organizational skills. Good interpersonal skills. Ability to work in a team environment. Ability to meet or exceed Performance Competencies.

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: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision and talking.

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.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $17.00. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com