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 interpretations.
Key Responsibilities:
- Make independent claim determinations to approve or deny complex disability claims
- Review and analyze complex medical information to determine if a claimant is disabled according to the disability plan
- Oversee additional facets of complex claims, such as comorbidities and concurrent plans
- Utilize 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 review contested claims
- Evaluate and arrange referrals of claims to outside vendors or physician advisors
- Negotiate return-to-work plans with or without job accommodations
Requirements:
- High school diploma or GED required; bachelor's degree preferred
- Three years of benefits or disability case management experience preferred
- 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
Work Environment:
- Sedgwick considers reasonable accommodations when applicable and appropriate
- Ability to sit at a desk for extended periods while operating a computer and phone system; travel may be required