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.
As an Advocacy Coordination Team Specialist, you will actively research, resolve, and administer escalated inquiries for all lines of business, including Family Medical Leave (FMLA), complex paid and unpaid state, military, and company-specific leaves, accommodations, disability and statutory claims. You will provide excellent customer service displaying care and empathy to callers regarding claims and execute 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.
Responsibilities:
- Make 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.
- Analyze and authorize leave, accommodation, disability, and statutory claims and determine benefits due pursuant to client plans, and state and federal regulations.
- Enter and adjust payments and evaluate file interface to support payment research and resolution.
- Communicate 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.
- Facilitate claim resolution and handle escalated calls with claimant, human resources managers, treating physician's office, client, or others with a goal of one-call resolution.
- Ensure claims files are coded correctly and that adequate documentation is in the claim.
- Review and analyze complex medical information to determine if the claimant is disabled as defined by the disability plan and take all necessary action to manage claims process to completion.
- Inform claimants and client of documentation required to process claims, required timeframes, payment information and claims status.
- Determine benefits due, make timely and accurate claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
- Maintain professional client relationships and adhere to client specific requirements such as service level expectations, regulatory requirements, and reporting.
- Meet the organization's quality program(s) minimum requirements.
Qualifications:
- High school diploma or GED required. Bachelor's degree from an accredited college or university preferred.
- 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.