Advocacy Coordination Team Specialist

Sedgwick•Dubuque, IA

1d•Hybrid

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance. Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near our Center of Excellence in Dubuque, IA. 4141 Westmark Drive, Dubuque, IA 52002. The primary purpose of this role is to actively research, resolve, and administer escalated inquiries for all lines of business, including but not limited to Family Medical Leave (FMLA), complex paid and unpaid state, military, and company-specific leaves, accommodations, disability and statutory claims. The specialist provides excellent customer service displaying care and empathy to callers regarding claims and executes technical and jurisdictional requirements for accurate claims processing, benefit review and interpretation of regulations, financial payment processing, and error correction of complex or high exposure claims. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

Requirements

High school diploma or GED required.
Three (3) years of related experience or equivalent combination of experience and education required to include two (2) 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 interpersonal communication skills, oral and written
Analytical, interpretive, and critical thinking skills
Effective decision-making
Ability to manage ambiguity
Strong organizational and multitasking skills
Ability to exercise judgement autonomously within established procedures
Ability to work in a team environment
Ability to meet or exceed performance competencies as required by program
Credit security clearance, confirmed via a background credit check, is required for this position.

Nice To Haves

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

Responsibilities

Makes independent claim determinations, based on the information received, to approve complex claims or make a recommendation to team lead to deny claims based on the requirements.
Analyzes and authorizes leave, accommodation, disability, and statutory claims and determines benefits due pursuant to client plans, and state and federal regulations.
Enters and adjusts payments and evaluates file interface to support payment research and resolution.
Communicates clearly and professionally with claimant and client on all aspects of the claims process including claim approval, decision authority level to move the call forward, and issue resolution by phone, written correspondence and/or claims system.
Facilitates claim resolution and handles escalated calls with claimant, human resources managers, treating physician’s office, client, or others with a goal of one-call resolution.
Ensures claims files are coded correctly and that adequate documentation is in the claim.
Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan and takes all necessary action to manage claims process to completion.
Informs claimants and client of documentation required to process claims, required timeframes, payment information and claims status.
Determines benefits due, makes timely and accurate claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
Maintains professional client relationships and adheres to client specific requirements such as service level expectations, regulatory requirements, and reporting.
Meets the organization’s quality program(s) minimum requirements.
Performs other duties as assigned.