Description
By joining Sedgwick, you'll be part of a team that makes a meaningful difference in people's lives.
As a Disability Specialist, 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 clinical resources in case assessment.
- Determines benefits due, makes timely claims payments and adjustments.
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status.
- Communicates with 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, thoroughly reviewing contested claims.
- Evaluates and arranges appropriate referral of claims to outside vendors.
- Negotiates return to work with or without job accommodations.
Requirements:
- High school diploma or GED required.
- 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.
- A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being.