Advocacy Coordination Team Specialist

Sedgwick•Dubuque, IA

1d•Hybrid

About The Position

By joining Sedgwick, you'll be part of something truly meaningful, contributing to what their 33,000 colleagues do daily for people facing unexpected challenges. The company invites growth, a caring culture, and work-life balance. Sedgwick is recognized as one of America’s Greatest Workplaces and a Great Place to Work®. This role is for an Advocacy Coordination Team Specialist, working in a hybrid arrangement with onsite collaboration at the Center of Excellence in Dubuque, IA. The work schedule is 9:30 am-6:00 pm CST, Monday-Friday. The primary purpose of the position is to actively research, resolve, and administer escalated inquiries across all lines of business, including FMLA, complex paid and unpaid state, military, and company-specific leaves, accommodations, disability, and statutory claims. The specialist provides excellent customer service, processes claims accurately, reviews benefits, interprets regulations, handles financial payments, and corrects errors for complex or high-exposure claims.

Requirements

High school diploma or GED required.
Three (3) years of related experience or equivalent combination of experience and education required.
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.