Advocacy Coordination Team Specialist

Sedgwick•Chicago, IL

10d•$22 - $24

About The Position

The Advocacy Coordination Team Specialist researches, resolves, and administers escalated inquiries across lines of business, including family 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, interpret regulations, process payments, and correct errors in complex or high-exposure claims. The specialist makes or recommends claim decisions, analyzes eligibility and benefits under client plans and applicable regulations, researches payment issues, and communicates with claimants, clients, and other parties by phone, correspondence, and claims systems. The position handles escalations with the goal of resolving issues in one call, maintains accurate claim documentation, reviews complex medical information, and manages claims through completion. It also supports timely and accurate payments, maintains client relationships, and meets quality and service requirements. The position requires adherence to a set schedule with established break times. A background credit check and credit security clearance are required. Sedgwick offers a comprehensive benefits package, including medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings accounts, and other voluntary benefits.

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 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 adhere to a set schedule with established break times.
Credit security clearance, confirmed via a background credit check.

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 to approve complex claims or recommend denial to a team lead based on applicable requirements.
Analyze and authorize leave, accommodation, disability, and statutory claims and 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 through phone calls, written correspondence, and 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 claim 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.
Inform claimants and clients about required documentation, timeframes, payment information, and claim status.
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 meet client-specific service, regulatory, and reporting requirements.
Meet the organization’s quality program minimum requirements.
Perform other duties as assigned.