Consumer Care Advocate (Part-time)

PRIMARY PURPOSE:

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

• 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.
• Collaborates with internal departments to coordinate claimant address updates or changes.
• Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
• Supports the organization's quality program(s).

Qualifications

• Education & Licensing:
  • A high school diploma or GED required.
  • An associate’s degree from an accredited college or university preferred.
  • A 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.

Additional Functions

• Performs other duties as assigned.

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.

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.