Claims Resolution & Leave Specialist

Sedgwick; Dubuque (IA); On-site; USD 52,000 - 74,000; Full time

Job summary

Sedgwick is seeking an Advocacy Coordination Team Specialist to research, resolve, and administer escalated inquiries across lines of business, including FMLA, disability, and statutory leaves. You will interpret regulations, process claims, and ensure accurate benefit determinations while maintaining customer care.

Role requires strong communication, analytical thinking, and ability to work with complex medical information to determine benefits and documentations. Travel may be required.

Qualifications

• Three (3) years of related experience or equivalent combination of experience and education.
• Experience with disability claims processing and regulations.
• Experience with HR systems preferred (SMART, SIR, GAIN, etc.).
• Strong knowledge of ERISA, FMLA, ADAAA requirements and disability procedures.

Responsibilities

• Makes independent claim determinations and approves or recommends claim outcomes.
• Analyzes and authorizes leave, accommodation, disability, and statutory claims.
• Enters and adjusts payments; supports payment research and resolution.
• Communicates with claimants, HR managers, and clients to resolve claims.
• Facilitates claim resolution and aims for one-call resolution where possible.
• Ensures claims files are well-documented and compliant.

Skills

ERISA regulations

FMLA

Disability claims

Medical terminology

Microsoft Office

Communication skills

Education

High school diploma

Bachelor's degree preferred

Tools

SMART

SIR

GAIN

TAMS

Juris

viaOne express

Job description

Sedgwick is seeking an Advocacy Coordination Team Specialist to research, resolve, and administer escalated inquiries across lines of business, including FMLA, disability, and statutory leaves. You will interpret regulations, process claims, and ensure accurate benefit determinations while maintaining customer care.

Role requires strong communication, analytical thinking, and ability to work with complex medical information to determine benefits and documentations. Travel may be required.