Advocacy Coordination Team Specialist

Sedgwick•Dubuque, IA

About The Position

The Advocacy Coordination Team Specialist researches, resolves, and administers escalated inquiries across multiple lines of business, including family and medical leave, complex paid and unpaid state, military, and company-specific leaves, accommodations, disability, and statutory claims. The role provides empathetic customer service while applying technical and jurisdictional requirements to process claims accurately, review benefits and regulations, process payments, and correct errors on complex or high-exposure claims. The specialist makes or recommends claim decisions, analyzes claims and determines benefits under client plans and applicable regulations, supports payment research, and communicates claim decisions and status to claimants and clients. The role handles escalated calls with the goal of resolving issues in one contact, maintains accurate claim coding and documentation, reviews complex medical information, and manages claims through completion. It also requires maintaining client relationships and meeting service, regulatory, reporting, and quality requirements. The position follows an established schedule with set break times. Reasonable accommodations will be considered where applicable and appropriate. The work involves extended periods sitting at a desk while using a computer and phone system, and travel as required. Mental demands include judgment, analysis, troubleshooting, handling stress and multiple priorities, and meeting deadlines. Hearing, vision, and talking are also required.

Requirements

High school diploma or GED.
Three years of related experience or an equivalent combination of experience and education, including two years of disability claims experience.
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.
Exemplary call-handling and de-escalation skills.
Excellent oral and written interpersonal communication skills.
Analytical, interpretive, and critical-thinking skills.
Effective decision-making skills.
Ability to manage ambiguity.
Strong organizational and multitasking skills.
Ability to exercise judgment autonomously within established procedures.
Ability to work in a team environment.
Ability to meet or exceed program performance competencies.
Ability to adhere to a set schedule with established break times.
Ability to sit at a desk for extended periods while operating a computer and phone system; travel as required.
Hearing, vision, and talking ability.

Nice To Haves

Bachelor’s degree from an accredited college or university.
Experience with SMART, SIR, GAIN, or other HR systems.
For internal candidates, experience with TAMS, Juris, viaOne express, and mySedgwick.

Responsibilities

Make independent claim determinations based on information received, approving complex claims or recommending denial to a team lead.
Analyze and authorize leave, accommodation, disability, and statutory claims; determine benefits under client plans and state and federal regulations.
Enter and adjust payments, and evaluate file interfaces to support payment research and resolution.
Communicate professionally with claimants and clients about the claims process, approvals, decision authority, and issue resolution by phone, written correspondence, or claims systems.
Facilitate claim resolution and handle escalated calls with claimants, human resources managers, treating physicians’ offices, clients, and others, aiming for one-call resolution.
Ensure claims files are coded correctly and contain adequate documentation.
Review and analyze complex medical information to determine disability under the applicable plan and take necessary actions to manage claims through completion.
Inform claimants and clients of required documentation, timeframes, payment information, and claim status.
Determine benefits due and make timely, accurate claim payments, approvals, and adjustments for workers’ compensation, Social Security Disability Income, and other disability offsets.
Maintain professional client relationships and comply with client-specific service level expectations, regulatory requirements, and reporting requirements.
Meet the organization’s minimum quality program requirements.
Perform other duties as assigned.