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Advocacy Coordination Team Specialist

Sedgwick

1 Positions

ID: R62182

Posted On 06/05/2025

Job Overview

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

**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. 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 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 you're excited about this role but your experience doesn't 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.

Primary Contact

1645458383738

Amanda Strothman

,

Phone

Phone

Phone

Fax

[email protected]

Email

True

False

True

Job Details

Categories

Insurance

Technical

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

8326

Job REQ #

R62182

\# Positions

1

Start Date

20250605

End Date

20250706

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Sedgwick

About the Company

Career Development

Our goal is to make Sedgwick CMS a place where great people can do great things for our clients. This commitment is evidenced by our colleague development program and supported by our multi-dimensional learning resources.

We invest in the education of our colleagues by providing training and learning resources that focus on our culture, procedures, systems and performance expectations. We evaluate the educational needs of our colleagues through performance discussions and evaluations. These needs are filled either through Sedgwick CMS University and through industry certification programs and other external educational resources . Sedgwick CMS University curriculum offerings take colleagues from orientation to technical training to supervisory and managerial development. Through Sedgwick CMS University, we provide our colleagues continuous development of professional skills and the ability to deliver quality service to our clients.

Colleague Orientation

We offer a required colleague orientation program that allows us to verify and document the training provided to new colleagues. This program is called Personal Responsibility in Developing Excellence (PRIDE) and is the first component of our comprehensive career development process. This program introduces and orients new and transitioning colleagues to our company and to their new position. PRIDE will take colleagues through the first 90 days of their new position. Objectives of this program focus on providing colleagues an increased awareness of who we are, where we are going, and how they can help us get there.

Career Paths

Career path options are identified through an ongoing process of discussion and collaboration between colleagues and their managers. On an ongoing basis, our managers counsel colleagues regarding their career path, new opportunities, and additional training and development requirements to help them reach their individual goals.