Advocacy Coordination Team Specialist

Sedgwick•Dubuque, IA

About The Position

The Advocacy Coordination Team Specialist researches, resolves, and administers escalated inquiries across lines of business, including FMLA, 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, interpret regulations, process payments, and correct errors on complex or high-exposure claims. The specialist makes independent claim determinations, analyzes and authorizes claims, determines benefits under client plans and applicable regulations, and communicates claim decisions and requirements to claimants and clients. The role handles escalations and supports resolution through phone, written correspondence, and claims systems; reviews complex medical information; manages claims through completion; and maintains accurate documentation, timely payments, client relationships, and compliance with service and regulatory requirements.

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 performance competencies required by the program.
Ability to adhere to a set schedule with established break times.
Ability to think clearly and conceptually, exercise judgment and discretion, troubleshoot and solve problems, handle work-related stress and multiple priorities, and meet deadlines.
Ability to sit at a desk for extended periods while operating a computer and phone system.
Hearing, vision, and talking abilities.

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 determinations on complex claims or recommend denial to a team lead based on applicable requirements.
Analyze and authorize leave, accommodation, disability, and statutory claims; determine benefits due under client plans and state and federal regulations.
Enter and adjust payments and evaluate file interfaces to research and resolve payment issues.
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 correctly coded and contain adequate documentation.
Review and analyze complex medical information to determine disability under the applicable plan and take necessary actions to complete claims processing.
Inform claimants and clients about required documentation, deadlines, payment information, and claim status.
Determine benefits due and make timely, accurate claim payments, approvals, and adjustments, including workers' compensation, SSDI, and other disability offsets.
Maintain professional client relationships and meet client-specific service-level, regulatory, and reporting requirements.
Meet the organization's minimum quality-program requirements.
Perform other duties as assigned.