Consumer Care Advocate

About the role

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.

Responsibilities

• Process 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.
• Communicate claims status and current claim activity with clients and appropriate medical contacts; respond to inquiries about jurisdiction- and claim-specific issues.
• Enter data into claims system(s) and ensure claim files are properly documented and claims coding is correct.
• Coordinate claimant address updates or changes with internal departments.
• Provide referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinate independent medical examinations.
• Perform other duties as assigned.
• Support the organization's quality program(s).

Requirements

• 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.
• 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

• 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.

When applicable and appropriate, consideration will be given to reasonable accommodations.