Advocacy Coordination Team Specialist

About the role

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

Responsibilities

• Researches, resolves, and administers escalated inquiries for various lines of business, including FMLA, paid and unpaid state, military, and company-specific leaves, accommodations, disability, and statutory claims.
• Provides excellent customer service, demonstrating care and empathy, and executing technical and jurisdictional requirements for accurate claims processing, benefit review, and interpretation of regulations.
• Enters and adjusts payments, evaluates file interfaces, and supports payment research and resolution.
• Communicates clearly and professionally with claimants and clients on all aspects of the claims process, including claim approval, decision authority levels, and issue resolution through phone, written correspondence, and claims system.
• Facilitates claim resolution and handles escalated calls with claimants, human resources managers, treating physicians' offices, clients, or others, aiming for one-call resolution.
• Maintains correct claim coding and ensures adequate documentation for claims.
• Reviews and analyzes complex medical information to determine if claimants are disabled as defined by the disability plan and manages claims processes to completion.
• Informs claimants and clients of required documentation, timelines, payment information, and claims status. Determines benefits due, makes timely and accurate claims payments/approvals, and adjustments for workers compensation, SSDI, and other disability offsets.
• Maintains professional client relationships and adheres to client-specific requirements such as service level expectations, regulatory requirements, and reporting.
• Maintains 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.