Advocacy & Claims Resolution Specialist

Sedgwick Claims Management Services Ltd; Chicago (IL); On-site; USD 30,000 - 32,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with match

PTO

Disability insurance

Life insurance

Employee assistance

FSA/HSA

Additional voluntary benefits

Job summary

Sedgwick Claims Management Services Ltd in Chicago, IL is seeking an Advocacy Coordination Team Specialist to actively research, resolve, and administer escalated inquiries across lines of business. Responsibilities include leave, disability, and statutory claims processing, benefit determinations, and high-quality customer service.

You will analyze medical information, communicate decisions to claimants and clients, and manage complex claims to completion while maintaining documentation and

Qualifications

• High school diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• Three years of related experience, including two years of disability claims.
• Experience with HR systems is preferred.
• Knowledge of ERISA regulations and disability procedures.

Responsibilities

• Makes independent claim determinations to approve complex claims or recommend denial.
• Analyzes and authorizes leave, accommodation, disability and statutory claims.
• Enters and adjusts payments and supports payment research and resolution.
• Communicates clearly with claimants and clients by phone, email or claims system.
• Facilitates claim resolution and aims for one-call resolution on escalated calls.
• Ensures proper coding and documentation in claims files.

Skills

Disability claims

ERISA regulations

Excellent communication

De-escalation skills

Microsoft Office

Analytical thinking

Education

High school diploma or GED

Bachelor's degree preferred

Tools

SMART

SIR

GAIN

Juris

viaOne express

mySedgwick

Job description

Sedgwick Claims Management Services Ltd in Chicago, IL is seeking an Advocacy Coordination Team Specialist to actively research, resolve, and administer escalated inquiries across lines of business. Responsibilities include leave, disability, and statutory claims processing, benefit determinations, and high-quality customer service.

You will analyze medical information, communicate decisions to claimants and clients, and manage complex claims to completion while maintaining documentation and