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 to join our team in Irving, TX. As a Disability Representative, you will provide disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation.
Responsibilities:
- Makes claim determinations, based on the information received, to approve routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
- Reviews and analyzes routine medical information to determine if the claimant is disabled as defined by the disability plan.
- Utilizes the appropriate clinical resources in case assessment.
- Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status.
- Communicates with the claimants' providers to set expectations regarding return to work.
- Medically manages routine disability claims ensuring compliance with duration control guidelines and plan provisions.
- Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
- Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
- Negotiates return to work with or without job accommodations via the claimant's physician and employer.
Requirements:
- High school diploma or GED required.
- State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
- Two (2) years of related experience or equivalent combination of education and experience required.
- One (1) year of office or customer service experience required.
- One (1) year of benefits or claims management experience preferred.
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures.
- Excellent oral and written communication, including presentation skills.
- Proficient computer skills including working knowledge of Microsoft Office.
- Analytical, interpretive, and critical thinking skills.
- Strong organizational and multitasking skills.
- Ability to work in a team environment.
What we offer:
- A stable, consistent work environment , both in-office and virtual.
- A comprehensive training program to help you support employees and customers from some of the world's most respected brands.
- A dedicated mentor and manager to guide you every step of your career journey.
- Career development and promotional opportunities as you take on new responsibilities.
- A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being.