Description
By joining Sedgwick, you'll be part of a global organisation that helps people facing unexpected challenges.
As a Disability Representative Sr, you will provide disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation.
Responsibilities:
- Makes independent claim determinations to approve complex disability claims or recommends denial to team lead
- Reviews and analyses complex medical information to determine if the claimant is disabled as defined by the disability plan
- Oversees additional facets of complex claims, including comorbidities, concurrent plans, and complex ADA accommodations
- Utilises clinical resources in case assessment as needed
- Determines benefits due and makes timely claims payments/approvals and adjustments
- Communicates with claimants, providers, and clients on all aspects of claims process
- Coordinates investigative efforts and provides thorough review of contested claims
- Evaluates and arranges referral of claims to outside vendors or physician advisor reviews
- Negotiates return to work with or without job accommodations
- Refers cases to team lead and clinical case management for additional review when necessary
- Maintains professional client relationships and provides 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
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