Advocacy Coordination Team Specialist

Sedgwick; Indianapolis (IN); Presencial; USD 52.000 - 75.000; Jornada completa

Descripción de la vacante

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

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

ERISA regulations knowledge

Medical terminology

Microsoft Office

Call handling skills

Interpersonal communication

Analytical thinking

Decision making

Ability to work in team

Time management

Educación

High school diploma or GED

Bachelor's degree preferred

Herramientas

SMART

SIR

GAIN

HR systems

TAMS

Juris

viaOne express

mySedgwick

Descripción del empleo

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

Work Schedule: 11:00a.m. - 7:00p.m. CST

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

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 back