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:
- Make independent claim determinations to approve complex disability claims or recommend denial based on disability plan
- Review and analyse complex medical information to determine claimant disability
- Oversee additional facets of complex claims, including comorbidities and complex ADA accommodations
- Utilise clinical resources in case assessment as needed
- Determine benefits due and make timely claims payments/approvals and adjustments
- Communicate with claimants, providers, and clients on claims process and status
- Medically manage complex disability claims and ensure compliance with duration control guidelines
- Coordinate investigative efforts and 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 lead and clinical case management for additional review
- Maintain professional client relationships and provide excellent customer service
Requirements:
- High school diploma or GED required; bachelor's degree preferred
- 3+ years of benefits or disability case/claims management 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
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: $24.00 - $26.00 USD Hourly