Advocacy Care Team
Posted on: January 27, 2023
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a
positive impact on the world through the people and organizations
we serve. If you are someone who is driven to make a difference,
who enjoys a challenge and above all, if you're someone who cares,
there's a place for you here. Join us and contribute to Sedgwick
being a great place to work.
Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer
Advocacy Care Team
**PRIMARY PURPOSE** **:** To actively research, resolve, and
administer escalated inquires 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 and interpretation of
regulations, financial payment processing, and error correction of
complex or high exposure claims.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ 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 claimant and client on all aspects of
the claims process including: claim approval, decision authority
level to move the call forward, and issue resolution.
+ Facilitates claim resolution with claimant, human resources
managers, treating physician's office, client, or other
+ 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 take all
necessary action to manage claims process to
+ Informs claimants and client of documentation required to process
claims, required timeframes, payment information and claims
+ Determines benefits due, makes timely claims payments/approvals
and adjustments for workers compensation, Social Security
Disability Income (SSDI), and other disability offsets.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**Education & Licensing**
Bachelor's degree from an accredited college or university
Three (3) years of related experience or equivalent combination of
experience and education required to include two (2) years of
disability claims experience. Experience with TAMS, Juris, SMART,
SIR, viaOne express, GAIN, or other HR system preferred.
**Skills & Knowledge**
+ Knowledge of ERISA regulations, FMLA, ADAAA, disability
procedures and basic clinical terminology.
+ Excellent oral and written communication skills
+ PC literate, 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
When applicable and appropriate, consideration will be given to
**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
**Physical** **:** Computer keyboarding, travel as required
**Auditory/Visual** **:** Hearing, vision and talking
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
**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
**Taking care of people is at the heart of everything we do. Caring
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing - one where caring
counts. Watch this video to learn more about us.
Keywords: Sedgwick, Springfield , Advocacy Care Team, Other , Springfield, Illinois
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