Advocacy Coordination Team Specialist

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 our centers of excellence:

Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826

Eden Prairie, MN : 11000 Prairie Lakes Drive Eden Prairie, MN 55344

Dublin, OH : 5500 Glendon Court Dublin OH 43016

New Albany, OH : 7795 Walton Parkway New Albany, OH 43054

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 time frames, 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. Bachelor's 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…