Sedgwick · 22 hours ago
Advocacy Coordination Team Specialist
Dubuque, IA
Full-time
Hybrid
Mid Level
$24.50/hr - $26.50/hr
3+ years expSedgwick is a company that supports individuals facing unexpected challenges, and they are seeking an Advocacy Coordination Team Specialist. The role involves researching and resolving escalated inquiries related to various claims, providing excellent customer service, and ensuring accurate claims processing and compliance with regulations.
BankingInsuranceRisk Management
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
Performs other duties as assigned
Qualification
Required
High school diploma or GED required
Three (3) years of related experience or equivalent combination of experience and education required to include two (2) years of disability claims experience
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
Credit security clearance, confirmed via a background credit check, is required for this position
Preferred
Bachelor's degree from an accredited college or university preferred
Experience with SMART, SIR, GAIN, or other HR systems preferred
Experience with TAMS, Juris, viaOne express, and mySedgwick preferred for internal candidates
Benefits
Medical
Dental
Vision
401k and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Company
Sedgwick
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersLa Caisse
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chairman & Chief Executive Officer
Kalani Reelitz
Global Chief Financial Officer
Recent News
Morningstar.com
2025-11-10
2025-09-04
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