Experienced Part-Time Remote Consumer Care Advocate – Customer Service and Claims Resolution Specialist

About Us

Sedgwick is a leading provider of technology-enabled risk, benefits, and integrated business solutions. Our mission is to help people and organizations achieve their goals by providing innovative solutions that address the complexities of risk, benefits, and integrated business. We are committed to delivering exceptional service, building strong relationships, and making a positive impact on the world through the people and organizations we serve.

Join Our Team

At Sedgwick, we believe that taking care of people is at the heart of everything we do. We start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring, which includes flexibility, time for personal pursuits, and support for your mental, physical, financial, and professional needs. We are a diverse, equitable, and inclusive workplace that celebrates individuality and promotes growth and development.

About the Role

We are seeking an experienced Part-Time Remote Consumer Care Advocate to join our team. As a key member of our customer service team, you will be responsible for providing high-quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time. This is a part-time remote position, working Monday through Friday, 3pm-8pm CST.

Key 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 clients and appropriate medical contacts; responds to inquiries about jurisdiction- and claim-specific issues.
• Enters data into claims systems 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 Responsibilities

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

Qualifications

We are looking for a motivated and experienced individual with a strong background in customer service and claims resolution. The ideal candidate will possess:

Education and Licensing

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

Experience

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

Skills and 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

We are committed to providing a safe and healthy work environment for all our employees. The physical demands of this role include:

• Computer keyboarding.
• Travel as required.

The mental demands of this role include:

• 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.
• Ability to meet deadlines.

The auditory/visual demands of this role include:

• Hearing.
• Vision.
• Talking.

Why Join Us?

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. We are committed to building a diverse, equitable, and inclusive workplace that celebrates individuality and promotes growth and development. If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now!

Ready to Apply?

Apply now by clicking on the link below:

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Don't Miss Out!

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.

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