Advocacy Coordination Team Specialist

About the role

Join Sedgwick, a leading provider of workplace solutions, where you'll contribute to making a difference in people's lives. Our 33,000 colleagues work tirelessly to support those facing unexpected challenges. At Sedgwick, we foster a caring culture and prioritize work-life balance.

Responsibilities

• Research, resolve, and administer escalated inquiries for various lines of business, including FMLA, paid and unpaid state, military, and company-specific leaves, accommodations, disability, and statutory claims.
• Analyze and authorize leave, accommodation, disability, and statutory claims, determining benefits due according to client plans and regulations.
• Enter and adjust payments, evaluate file interfaces, and support payment research and resolution.
• Communicate with claimants and clients, providing clear and professional guidance throughout the claims process, including approvals, decisions, and issue resolution.
• Facilitate claim resolution and handle escalated calls, ensuring one-call resolution and managing complex or high-exposure claims.
• Maintain correct claim coding and ensure adequate documentation for claims processing.
• Review and analyze complex medical information to determine disability eligibility and take necessary actions to manage claims.
• Inform claimants and clients about required documentation, timelines, payment information, and claims status.
• Determine benefits due, make timely and accurate claims payments/approvals and adjustments for workers compensation, SSDI, and other disability offsets.
• Maintain professional client relationships and adhere to specific requirements such as service level expectations, regulatory requirements, and reporting.
• Meet the organization's quality program(s) minimum requirements.

Qualifications

• High school diploma or GED required. Bachelor's degree from an accredited college or university preferred.
• Three (3) years of related experience or equivalent combination of experience and education, including two (2) years of disability claims experience.
• Experience with SMART, SIR, GAIN, or other HR systems preferred.
• Experience with TAMS, Juris, viaOne express, and mySedgwick preferred for internal candidates.