Advocacy Coordination Team Specialist

Sedgwick•Orlando, FL

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 and regulations, process payments, and correct errors in complex or high-exposure claims. The specialist independently evaluates complex claims, determines or recommends claim outcomes, interprets applicable plans and regulations, and manages claims through resolution. The position involves reviewing medical information, communicating with claimants and clients, coordinating with relevant parties, maintaining accurate files, and making timely benefit payments and adjustments. The role also requires adherence to client requirements, service expectations, regulatory obligations, reporting requirements, and organizational quality standards.

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 as 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.
Ability to travel as required.
Hearing, vision, and talking abilities.
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

Independently determine whether complex claims should be approved based on available information, or recommend denial to a team lead.
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 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, with a goal of one-call resolution.
Ensure claims files are correctly coded and adequately documented.
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 about required documentation, deadlines, payment information, and claim status.
Determine benefits due and make timely, accurate claim payments, approvals, and adjustments for workers’ compensation, SSDI, 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.