Advocacy Coordination Team Specialist

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

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Advocacy Coordination Team Specialist

PRIMARY PURPOSE : Actively researches, resolves, and administers escalated inquires for all lines of business, including but not limited to Family Medical Leave (FMLA), complex paid and unpaid state, military, and company-specific leaves, accommodations, disability and statutory claims. Provides excellent customer service displaying care and empathy to callers regarding claims and executes 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.

ESSENTIAL FUNCTIONS and 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing

High school diploma or GED required. Bachelors degree from an accredited college or university preferred.

Experience

Three (3) years of related experience or equivalent combination of experience and education required to include two (2) years of disability claims experience. Experience with SMART, SIR, GAIN, or other HR systems preferred. Experience with TAMS, Juris, viaOne express, and mySedgwick preferred for internal candidates.

Skills & Knowledge

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

WORK ENVIRONMENT

Required to adhere to a set schedule with established break times. When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical : Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.

Auditory/Visual : Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If youre excited about this role but your experience doesnt align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)