Advocacy Coordination Team Specialist

Sedgwick•Chicago, IL

About The Position

The Advocacy Coordination Team Specialist researches, resolves, and administers escalated inquiries across lines of business, including family and medical leave, complex paid and unpaid state, military and company-specific leaves, accommodations, disability, and statutory claims. The role provides empathetic customer service to callers and applies technical and jurisdictional requirements to process claims accurately, review benefits, interpret regulations, process payments, and correct errors involving complex or high-exposure claims. The specialist evaluates claims and benefits under client plans and applicable state and federal regulations, reviews medical information, communicates claim decisions and status, and works to resolve escalated issues. The role also maintains accurate claim files and client relationships while meeting service, regulatory, and quality 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 and the ability to manage ambiguity.
Strong organizational and multitasking skills.
Ability to exercise judgment autonomously within established procedures and work in a team environment.
Ability to meet or exceed performance competencies required by the program.
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; travel as required.
Hearing, vision, and talking abilities.
Credit security clearance confirmed through a background credit check.

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

Make independent determinations on complex claims or recommend denial to a team lead based on claim requirements.
Analyze and authorize leave, accommodation, disability, and statutory claims and determine benefits under client plans and applicable 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 claim processes, decisions, approvals, 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 the goal of one-call resolution.
Ensure claim files are correctly coded and contain adequate documentation.
Review and analyze complex medical information to determine disability under the applicable disability plan and manage claims through completion.
Inform claimants and clients about required documentation, timeframes, 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.