Advocacy Coordination Team Specialist

Sedgwick•Dubuque, IA

12d•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 Advocacy Coordination Team Specialist Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of these two Centers of Excellence: Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002 PRIMARY PURPOSE: To actively research, resolve, and administer escalated inquires for all lines of business including but not limited to FMLA, Accommodations, and disability claims; and to execute 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.

Requirements

Bachelor's degree from an accredited college or university preferred.
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, FMLA, ADAAA, disability procedures and basic clinical terminology.
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Excellent interpersonal skills
Strong organizational skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Nice To Haves

Experience with TAMS, Juris, SMART, SIR, viaOne express, GAIN, or other HR system preferred.

Responsibilities

Analyzes and authorizes claims and determines benefits due pursuant to a plan.
Enters and adjusts payments and evaluates file interface to support payment research and resolution.
Communicates clearly 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.
Facilitates claim resolution with claimant, human resources managers, treating physician’s office, client, or other callers.
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 take 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 claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
Performs other duties as assigned.
Supports the organization's quality program(s).