Disability Representative Sr

By joining Sedgwick, you'll be part of a global organisation that helps people facing unexpected challenges.

As a Disability Representative Sr, your primary purpose will be to provide disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretations.

Key Responsibilities:

• Make independent claim determinations to approve complex disability claims or recommend denials based on disability plans
• Review and analyse complex medical information to determine if claimants are disabled as defined by the disability plan
• Oversee additional facets of complex claims, including comorbidities, concurrent plans, and complex ADA accommodations
• Utilise clinical resources in case assessments as needed
• Determine benefits due and make timely claims payments and adjustments
• Communicate with claimants, providers, and clients throughout the claims process
• Coordinate investigative efforts and thoroughly review contested claims
• Evaluate and arrange referrals of claims to outside vendors or physician advisor reviews
• Negotiate return to work with or without job accommodations
• Refer cases to team leads and clinical case management for additional review when necessary
• Maintain professional client relationships and provide excellent customer service

Requirements:

• High school diploma or GED required; bachelor's degree preferred
• Three years of benefits or disability case/claims management experience or equivalent combination of education and experience
• Knowledge of ERISA regulations, disability duration and medical management practices, and Social Security application procedures
• Excellent oral and written communication skills
• Proficient computer skills, including Microsoft Office
• Analytical, interpretive, and critical thinking skills
• Ability to manage ambiguity and work in a team environment

Work Environment:

• Ability to sit at a desk for extended periods while operating a computer and phone system
• Travel may be required
• Consideration will be given to reasonable accommodations