Description
By joining Sedgwick, you'll be part of a global organisation that helps people facing unexpected challenges.
We're looking for a Disability Representative Sr to work in our hybrid environment with on-site collaboration near our Center of Excellence in Eden Prairie, Minnesota.
Primary Purpose: Provides disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation.
Key Responsibilities:
- Makes independent claim determinations to approve complex disability claims or recommends denial based on the disability plan.
- 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 thoroughly reviews contested claims.
- Evaluates and arranges referrals of claims to outside vendors or physician advisor reviews.
- Negotiates return to work with or without job accommodations.
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, analytical, interpretive, and critical thinking skills.
- Proficient computer skills, including Microsoft Office.
What We Offer:
- Competitive salary: $21.00 - $25.00 USD Hourly
- Comprehensive benefits package, including medical, dental, vision, 401k and matching, PTO, disability and life insurance, and employee assistance programmes.