Description
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.
The Advocacy Coordination Team Specialist role involves providing disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation. This includes determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims, coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors.
Key Responsibilities:
- Makes claim determinations to approve routine disability claims or recommends denial based on the disability plan.
- Reviews and analyzes medical information to determine if the claimant is disabled as defined by the disability plan.
- Utilizes clinical resources in case assessment regularly.
- Determines benefits due and makes timely claims payments and adjustments.
- Informs claimants of documentation required to process claims, required time frames, payment information, and claims status.
- Communicates with claimants' providers to set expectations regarding return to work.
- Medically manages routine disability claims ensuring compliance with duration control guidelines and plan provisions.
- Coordinates investigative efforts and provides thorough review of contested claims.
- Evaluates and arranges appropriate referral of claims to outside vendors.
- Negotiates return to work with or without job accommodations.
Requirements:
- High school diploma or GED required.
- State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
- Two (2) years of related experience or equivalent combination of education and experience required.
- One (1) year of office or customer service experience required.
- One (1) year of benefits or claims management experience preferred.
Skills & Knowledge:
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures.
- Knowledge of state and federal FMLA regulations.
- Working knowledge of medical terminology and duration management.
- Excellent oral and written communication, including presentation skills.
- Proficient computer skills including working knowledge of Microsoft Office.
- Analytical, interpretive, and critical thinking skills.
- Strong organizational and multitasking skills.
- Ability to work in a team environment.
- Effective decision-making and negotiation skills.
- Ability to exercise judgement with limited supervision.
Work Environment:
- Ability to sit at a desk for extended periods while operating a computer and phone system.
- Travel as required.
Salary: For the jurisdiction noted in this job posting only, the range of starting pay for this role is $25.00 USD hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.