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
- Review and analyse complex medical information to determine if the claimant is disabled
- 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
- Communicate with claimants, providers, and clients throughout the claims process
- Coordinate investigative efforts and negotiate return to work with or without job accommodations
- Evaluate and arrange referrals to outside vendors or physician advisor reviews
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
- Proficient computer skills, including Microsoft Office
- Analytical, interpretive, and critical thinking skills
Work Environment:
- Hybrid work arrangement with onsite collaboration
- Must live near one of Sedgwick's centres of excellence
Benefits:
- (No benefits mentioned)