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 concurrent plans
- Utilise clinical resources in case assessment as needed
- Determine benefits due and make timely claims payments/approvals and adjustments
- Inform claimants of documentation required to process claims and communicate with providers
- Medically manage complex disability claims and negotiate return to work with or without job accommodations
- Coordinate investigative efforts and evaluate claims for referral to outside vendors
- 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 preferred
- Knowledge of ERISA regulations, disability duration and medical management practices, and Social Security application procedures
- Excellent oral and written communication skills and proficient computer skills, including Microsoft Office
- Analytical, interpretive, and critical thinking skills, with ability to manage ambiguity and meet performance competencies
Work Environment:
- Ability to sit at a desk for extended periods while operating a computer and phone system
- Travel as required