Consumer Care Advocate

Sedgwick; Texas; Hybrid; USD 32,000 - 42,000; Full time

Job summary

Sedgwick in Texas is seeking a Consumer Care Advocate to deliver high-quality service to internal and external customers, providing an easy and efficient experience for routine lost time.

You will handle calls, faxes, and voicemails from claimants, providers, clients, and attorneys; document claims; update addresses; coordinate with SIU and independent medical exams; and support quality programs across the organization.

Qualifications

• High school diploma or GED required.
• Associate’s degree preferred.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving questions and issues per guidelines.
• Communicates claims status and activity with client and medical contacts; responds to jurisdiction- and claim-specific inquiries.
• Enters data into claims system and ensures proper documentation and coding.
• Coordinates claimant address updates with internal departments.
• Provides referrals to legal, utilization review, pharmacy, and SIU as needed; coordinates independent medical exams.

Skills

Excellent oral and written comms

PC literacy (MS Office)

Investigation skills

Interpersonal skills

Teamwork

Performance competencies

Education

High school diploma or GED

Associate’s degree preferred

Professional certification preferred

Tools

None

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

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 judgement, 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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.