Advocacy Coordination Team Specialist

About the role

Join Sedgwick, a company dedicated to supporting people worldwide through unexpected challenges. We offer a caring culture and work-life balance, where you can grow your career and make a difference.

Responsibilities

• Research, resolve, and administer escalated inquiries for all lines of business, including FMLA, complex paid and unpaid state, military, and company-specific leaves, accommodations, disability, and statutory claims.
• Analyze and authorize leave, accommodation, disability, and statutory claims and determine benefits due according to client plans and state/federal regulations.
• Enter and adjust payments, evaluate file interfaces, and support payment research and resolution.
• Communicate clearly and professionally with claimants and clients on all aspects of the claims process, including claim approval, decision authority levels, and issue resolution by phone, written correspondence, and claims system.
• Facilitate claim resolution and handle escalated calls with claimants, human resources managers, treating physician’s offices, clients, or others with a goal of one-call resolution.
• Maintain correct claim coding and ensure adequate documentation for claims.
• Review and analyze complex medical information to determine if claimants are disabled as defined by the disability plan and take necessary actions to manage claims process to completion.
• Inform claimants and clients of 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 client-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 required, 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.

Skills & Knowledge

• Knowledge of ERISA regulations, state and federal FMLA, ADAAA, Social Security application procedures, required offsets and deductions, and disability procedures.
• Working knowledge of medical terminology and duration management.
• Proficient computer skills including working knowledge of Microsoft Office.
• Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion.
• Able to handle work-related stress; able to handle multiple priorities simultaneously; and able to meet deadlines.
• Ability to sit at a desk for extended periods while operating a computer and phone system.
• Ability to travel as required.
• Auditory/Visual: Hearing, vision, and talking.

Work Environment

• Required to adhere to a set schedule with established break times.
• When applicable and appropriate, consideration will be given to reasonable accommodations.

Benefits

• Comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Pay

The range of starting pay for this role is $23.50-$25.50. Please note that actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location.