Description

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 : To actively research, resolve, and administer escalated inquires for all lines of business including but not limited to FMLA, Accommodations, and disability claims; and to execute 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

• Analyzes and authorizes claims and determines benefits due pursuant to a plan.
• Enters and adjusts payments and evaluates file interface to support payment research and resolution.
• Communicates clearly 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.
• Facilitates claim resolution with claimant, human resources managers, treating physician's office, client, or other callers.
• 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 take 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 claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
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 TAMS, Juris, SMART, SIR, viaOne express, GAIN, or other HR system preferred.

Skills & Knowledge

• Knowledge of ERISA regulations, FMLA, ADAAA, disability procedures and basic clinical terminology.
• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Excellent interpersonal skills
• Strong organizational skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
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 : Computer keyboarding, travel as required

Auditory/Visual : Hearing, vision and talking

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.
Requisition #: R67132

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