Advocacy Coordination Team Specialist

Advocacy Coordination Team Specialist

Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002

Work Schedule: 9:30 am – 6:00 pm CST, Monday–Friday

To actively research, resolve, and administer escalated inquiries for all lines of business, including but not limited to FMLA, accommodations, and disability claims; and to execute technical and jurisdictional requirements for accurate claims processing, benefit review, regulation interpretation, financial payment processing, and error correction of complex or high‑exposure claims.

• Analyzes and authorizes claims and determines benefits due pursuant to a plan.
• Enters and adjusts payments and evaluates file interface to support payment research and resolution.
• Communicates clearly with claimants and clients on all aspects of the claims process, including claim approval, decision authority level, and issue resolution.
• Facilitates claim resolution with claimants, human resources managers, treating physician’s office, clients, or other callers.
• Ensures claims files are coded correctly and that adequate documentation is in the claim.
• Reviews and analyzes complex medical information (e.g., diagnostic tests, office notes, operative reports) to determine if the claimant is disabled as defined by the disability plan and takes all necessary action to manage the claims process to completion.
• Informs claimants and clients of documentation required to process claims, required time frames, payment information, and claims status.
• Determines benefits due, makes timely claims payments/approvals and adjustments for workers’ compensation, Social Security Disability Income (SSDI), and other disability offsets.

• Performs other duties as assigned.
• Supports the organization’s quality program(s).

Bachelor’s degree from an accredited college or university preferred.

Three (3) years of related experience or an equivalent combination of experience and education is required, including two (2) years of disability claims experience. Experience with TAMS, Juris, SMART, SIR, viaOne Express, GAIN, or other HR system preferred.

• Knowledge of ERISA regulations, FMLA, ADAAA, disability procedures, and basic clinical terminology.
• Excellent oral and written communication skills.
• PC literacy, including Microsoft Office products.
• Analytical and interpretive skills.
• Excellent interpersonal skills.
• Strong organizational skills.
• Ability to work in a team environment.
• Ability to meet or exceed performance competencies.

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem‑solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision, and talking.

When applicable and appropriate, consideration will be given to reasonable accommodations.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.