Advocacy & Leave Claims Specialist

Sedgwick Claims Management Services Ltd; Orlando (FL); On-site; USD 55,000 - 70,000; Full time

Job summary

Sedgwick Claims Management Services Ltd in Orlando, FL is seeking an Advocacy Coordination Team Specialist to closely research, resolve, and administer escalated inquiries across leave, disability, and regulatory claims. The role emphasizes care, empathy, accuracy, and compliance with ERISA, FMLA, and state regulations.

You will review complex medical information, determine eligibility, communicate decisions to claimants and clients, and support one-call resolution while maintaining

Qualifications

• Requires a high school diploma or GED; bachelor's degree preferred.
• Three years of related experience or an equivalent combination; two years in disability claims.
• Knowledge of ERISA, FMLA, ADAAA, Social Security procedures, and disability processes.

Responsibilities

• Researches, resolves, and administers escalated inquiries for FMLA, disability, and related leaves.
• Determines benefits due and authorizes claims payments with accuracy per client plans and regulations.
• Communicates decisions clearly to claimants, HR, and clients by phone, mail, or claims system.
• Facilitates claim resolution and aims for one-call resolution while documenting all actions.
• Reviews medical information to assess disability status and ensure proper claims processing.
• Maintains documentation and adheres to service levels and regulatory requirements.

Skills

ERISA regulations

FMLA & ADA/ADAAA

Social Security procedures

Medical terminology

MS Office

Analytical thinking

Decision making

Communication skills

Teamwork

Ambiguity management

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

SMART

SIR

GAIN

Juris

viaOne express

mySedgwick

TAMS

Job description

Sedgwick Claims Management Services Ltd in Orlando, FL is seeking an Advocacy Coordination Team Specialist to closely research, resolve, and administer escalated inquiries across leave, disability, and regulatory claims. The role emphasizes care, empathy, accuracy, and compliance with ERISA, FMLA, and state regulations.

You will review complex medical information, determine eligibility, communicate decisions to claimants and clients, and support one-call resolution while maintaining