Consumer Care Advocate

Sedgwick • Telecommuter TX, TX

1d

About The Position

The Consumer Care Advocate provides high-quality service to internal and external customers, delivering an easy and efficient customer experience for routine lost time. The role handles incoming inquiries related to claims, communicates claim status and activity, maintains accurate claim records, coordinates address updates, and makes referrals or arrangements for appropriate services. The position also supports the organization's quality programs and performs other duties as assigned.

Requirements

• High school diploma or GED.
• Two years of administrative and/or customer service experience, or an equivalent combination of education and experience.
• Excellent oral and written communication skills.
• PC literacy, 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.

Nice To Haves

• Associate’s degree from an accredited college or university.
• Professional certification applicable to the line of business.

Responsibilities

• Process incoming calls, faxes, and voicemails from claimants, providers, clients, attorneys, and others, resolving claims-related questions and issues according to established guidelines and policies.
• Communicate claim status and current claim activity with clients and appropriate medical contacts, and respond to inquiries about jurisdiction- and claim-specific issues.
• Enter data into claims systems 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 the Special Investigations Unit (SIU) as appropriate, and coordinate independent medical examinations.
• Perform other duties as assigned.
• Support the organization's quality program(s).

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED