Description
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