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, interpret regulations, process financial payments, and correct errors on complex or high-exposure claims. The specialist independently makes claim determinations, analyzes and authorizes claims, reviews complex medical information, determines benefits due, and processes timely and accurate approvals, payments, and adjustments. The role communicates with claimants, clients, human resources managers, treating physicians, and others to resolve escalated issues, explain required documentation and timeframes, and work toward one-call resolution. The position also ensures accurate file coding and documentation, maintains professional client relationships, and meets quality and performance 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 and meet or exceed program performance competencies.
Ability to adhere to a set schedule with established break times.
Ability to sit at a desk for extended periods while operating a computer and phone system.
Ability to travel as required.
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 complex claims based on available information, approving claims or recommending denials to a team lead according to applicable requirements.
Analyze and authorize leave, accommodation, disability, and statutory claims, and determine benefits 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, 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 claims files are correctly coded and contain adequate documentation.
Review and analyze complex medical information to determine disability under the applicable plan and manage claims through completion.
Inform claimants and clients about required documentation, processing timeframes, payment information, and claim status.
Determine benefits due and make timely, accurate claims payments, approvals, and adjustments involving 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.