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Disability Representative Sr
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join
Sedgwick's talented team of 27,000 colleagues around the globe.
Sedgwick is a leading provider of technology-enabled risk, benefits
and integrated business solutions. Taking care of people is at the
heart of everything we do. Millions of people and organizations
count on Sedgwick each year to take care of their needs when they
face a major life event or something unexpected happens. Whether
they have a workplace injury, suffer property or financial loss or
damage from a natural or manmade disaster, are involved in an auto
or other type of accident, or need time away from work for the
birth of a child or another medical situation, we are here to
provide compassionate care and expert guidance. Our clients depend
on our talented colleagues to take care of their most valuable
assets-their employees, their customers and their property. At
Sedgwick, caring counts. Join our team of creative and caring
people of all backgrounds, and help us make a difference in the
lives of others.
PRIMARY PURPOSE: To provide disability case management and claim
determinations based on complex medical documentation and the
applicable disability plan interpretation including determining
benefits due and making timely payments/approvals and adjustments,
medically managing disability claims; coordinating investigative
efforts, thoroughly reviewing contested claims, negotiating return
to work with or without job accommodations, and evaluating and
arranging appropriate referral of claims to outside vendors.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Analyzes, approves and authorizes assigned claims and
determines benefits due pursuant to a disability plan.
- Reviews and analyzes complex medical information (i.e.
diagnostic tests, office notes, operative reports, etc.) to
determine if the claimant is disabled as defined by the disability
- Utilizes the appropriate clinical resources in case assessment
(i.e. duration guidelines, in-house clinicians).
- Communicates with the claimants providers to set expectations
regarding return to work.
- Determines benefits due, makes timely claims payments/approvals
and adjustments for workers compensation, Social Security
Disability Income (SSDI), and other disability offsets.
- Medically manages disability claims ensuring compliance with
duration control guidelines and plan provisions.
- Communicates clearly with claimant and client on all aspects of
claims process either by phone and/or written correspondence.
- Informs claimants of documentation required to process claims,
required time frames, payment information and claims status either
by phone, written correspondence and/or claims system.
- Coordinates investigative efforts ensuring appropriateness;
provides thorough review of contested claims.
- Evaluates and arranges appropriate referral of claims to
outside vendors or physician advisor reviews, surveillance,
independent medical evaluation, functional capability evaluation,
and/or related disability activities.
- Negotiates return to work with or without job accommodations
via the claimants physician and employer.
- Refers cases as appropriate to team lead and clinical case
- Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Education & Licensing
Bachelor's degree from an accredited university or college
Three (3) years of benefits or disability case/claims management
experience or equivalent combination of education and experience
Skills & Knowledge
- Knowledge of ERISA regulations, required offsets and
deductions, disability duration and medical management practices
and Social Security application procedures
- Working knowledge of medical terminology and duration
- Excellent oral and written communication, including
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Ability to work in a team environment
- Excellent negotiation skills
- Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to
Mental: Clear and conceptual thinking ability; excellent
judgment, troubleshooting, problem solving, analysis, and
ability to handle work-related stress; ability to handle
multiple priorities simultaneously; and ability to meet
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background
credit check, is required for this position.
The statements contained in this document are intended to
describe the general nature and level of work being performed by a
colleague assigned to this description. They are not intended to
constitute a comprehensive list of functions, duties, or local
variances. Management retains the discretion to add or to change
the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free