Advocacy Coordination Team Specialist

Sedgwick•Indianapolis, IN

About The Position

The Advocacy Coordination Team Specialist researches, resolves, and administers escalated inquiries across 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 delivers empathetic customer service while applying technical and jurisdictional requirements to process claims accurately, review benefits, interpret regulations, process payments, and correct errors in complex or high-exposure claims. The specialist makes independent claim determinations, analyzes and authorizes claims, determines benefits under client plans and applicable regulations, and handles payment research and adjustments. The role communicates claim decisions, requirements, timelines, payment information, and status to claimants and clients; resolves escalated issues with claimants, human resources, medical offices, clients, and others; and maintains accurate, sufficiently documented files. It also reviews complex medical information to assess disability under applicable plans, manages claims through completion, and maintains client relationships while meeting service, regulatory, reporting, and quality requirements. The position follows an established schedule of 11:00 a.m. to 7:00 p.m. CST, with set break times. It requires extended periods sitting at a desk while using a computer and phone system, and travel as required. A credit security clearance confirmed through a background credit check is 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.
Strong oral and written interpersonal communication skills.
Analytical, interpretive, and critical-thinking skills.
Effective decision-making skills and ability to manage ambiguity.
Strong organizational and multitasking skills.
Ability to exercise judgment autonomously within established procedures.
Ability to work in a team environment and meet or exceed program performance competencies.
Ability to handle work-related stress, manage multiple priorities, and meet deadlines.
Ability to sit at a desk for extended periods while operating a computer and phone system.
Ability to travel as required.
Credit security clearance confirmed via a background credit check is required.

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

Research, resolve, and administer escalated inquiries and complex claims across applicable lines of business.
Make independent claim determinations, approve complex claims, or recommend denials to a team lead based on applicable requirements.
Analyze and authorize leave, accommodation, disability, and statutory claims, determining benefits due 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 claim processing, approvals, decision authority, requirements, timeframes, payment information, status, and issue resolution by phone, written correspondence, and claims systems.
Facilitate claim resolution and handle escalated calls with claimants, human resources managers, treating physician offices, clients, and others, aiming for one-call resolution.
Ensure claim files are correctly coded and contain adequate documentation.
Review and analyze complex medical information to determine whether a claimant is disabled under the disability plan, and take necessary action to manage the claim through completion.
Determine benefits due and make timely, accurate claims 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.
Meet the organization's minimum quality program requirements.
Perform other duties as assigned.