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 invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
As a Sr. Disability Representative, your primary purpose will be to provide disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation. This includes determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims, and coordinating investigative efforts.
Key responsibilities:
- Make independent claim determinations to approve complex disability claims or recommend denial based on the disability plan
- Review and analyze complex medical information to determine if the claimant is disabled as defined by the disability plan
- Oversee additional facets of complex claims, including comorbidities, concurrent plans, and complex ADA accommodations
- Utilize clinical resources in case assessment as needed
- Determine benefits due and make timely claims payments/approvals and adjustments
- Communicate with claimants, providers, and clients throughout the claims process
- Medically manage complex disability claims to ensure compliance with duration control guidelines and plan provisions
- 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 to team lead and clinical case management for additional review when appropriate
- 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 preferred
- Knowledge of ERISA regulations, 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
- Proficient computer skills, including Microsoft Office
- Analytical, interpretive, and critical thinking skills
- Ability to manage ambiguity and meet or exceed performance competencies
- Effective decision-making and negotiation skills
- Ability to exercise judgement autonomously within established procedures
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 range: $26.00 - $28.00 USD Hourly