Advocacy & Claims Resolution Specialist

Sedgwick; Indianapolis (IN); On-site; USD 52,000 - 75,000; Full time

Job summary

Sedgwick is seeking an Advocacy Coordination Team Specialist in Indianapolis to actively research, resolve, and administer escalated inquiries across leaves and disability claims. You will handle complex eligibility determinations and ensure accurate processing in line with ERISA regulations and client policies.

The role emphasizes high-quality customer service, precise documentation, and collaboration with HR and clients to achieve timely, one-call resolutions while maintaining performance

Qualifications

• Three years of related experience, including two years in disability claims.
• Experience with HR systems such as SMART, SIR, GAIN; internal tools preferred.
• Knowledge of ERISA regulations and FMLA/ADA/SSDI procedures.
• Strong analytical, communication, and problem-solving skills.

Responsibilities

• Make independent claim determinations on complex claims or recommend denial to team lead.
• Analyze and authorize leave, accommodation, disability, and statutory claims per client plans and regulations.
• Enter and adjust payments and support research for resolution.
• Communicate clearly with claimants, HR, and clients on all aspects of the claims process.
• Facilitate claim resolution and aim for one-call resolution; escalate as needed.
• Ensure claims files are properly coded and documented.
• Review medical data to determine disability status and manage claims to completion.
• Inform claimants and clients of required documentation, timeframes, and status.
• Determine benefits due and process timely payments and adjustments across disability programs.
• Maintain compliant relationships with clients and meet quality program requirements.

Skills

ERISA regulations knowledge

Medical terminology

Microsoft Office

Call handling skills

Interpersonal communication

Analytical thinking

Decision making

Ability to work in team

Time management

Education

High school diploma or GED

Bachelor's degree preferred

Tools

SMART

SIR

GAIN

HR systems

TAMS

Juris

viaOne express

mySedgwick

Job description

Sedgwick is seeking an Advocacy Coordination Team Specialist in Indianapolis to actively research, resolve, and administer escalated inquiries across leaves and disability claims. You will handle complex eligibility determinations and ensure accurate processing in line with ERISA regulations and client policies.

The role emphasizes high-quality customer service, precise documentation, and collaboration with HR and clients to achieve timely, one-call resolutions while maintaining performance