Customer Experience Advocate

The Customer Experience Advocate provides exceptional customer service to clients and their employees by handling calls in a timely, accurate, and professional manner.

This role is responsible for one contact resolution for any issues reported via phone or email.


* High School diploma.


* Two years of years of STD/LTD claims adjudication experience.


* Experienced in the TPA or self-administration services preferred.


* Experience with FMLA/State leave claims preferred.


* Ability to learn medical terminology and conditions.


* Ability to interpret procedures and regulations.


* Knowledgeable in Excel, Word, and web-based systems.


* Excellent verbal and written communication skills.


* Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures.


* Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.


* Strong ability to identify, analyze and solve problems.


* Effective interpersonal skills capable of dealing with external sources and all levels of employees.

#LI-DV1


* Responsible for pilot line calls and email communications resulting in reactionary responses within the claim.


* Manages and authorizes payment on claims while meeting all service, timeframe, and productions standards.


* Communicates with claimants, employers, and medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of benefits.


* Applies the appropriate contractual provisions, case management resources, and claim processes to ensure eligibility requirements and liability decisions are accurate.


* Responsible for de-escalating calls submitted by Absence Specialists.


* Responsible for providing excellent customer service and industry knowledge to inquiries.


* Assists in the training of new employees as needed.


* Performs other duties as assigned.


* Upholds the Crawford Code of Conduct.