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're looking for a Disability Representative Sr to join our team. The successful candidate will provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation.
Responsibilities:
- Analyze, approve and authorize assigned claims and determine benefits due pursuant to a disability plan.
- Review and analyze complex medical information to determine if the claimant is disabled as defined by the disability plan.
- Utilize clinical resources in case assessment.
- Communicate with claimants' providers to set expectations regarding return to work.
- Determine benefits due, make timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
- Medically manage disability claims ensuring compliance with duration control guidelines and plan provisions.
- Communicate clearly with claimants and clients on all aspects of claims process.
- Coordinate investigative efforts and provide thorough review of contested claims.
- Evaluate and arrange appropriate referral of claims to outside vendors or physician advisor reviews.
- Negotiate return to work with or without job accommodations.
- Refer cases as appropriate to team lead and clinical case management.
- Maintain professional client relationships.
Requirements:
- Bachelor's degree from an accredited university or college preferred.
- Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required.
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures.
- Working knowledge of medical terminology and duration management.
- Excellent oral and written communication, including presentation skills.
- PC literate, including Microsoft Office products.
- Analytical and interpretive skills.
- Strong organizational skills.
- Ability to work in a team environment.
- Excellent negotiation skills.
Benefits:
- Comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Salary:
- The range of starting pay for this role is $23.00 USD hourly.