Disability Representative Sr

Sedgwick

76d

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Representative Sr.

Requirements

• High School diploma or GED required.
• Bachelor's degree from an accredited university or college preferred.
• State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures.
• Knowledge of California VDI regulations required.
• Knowledge of state and federal FMLA regulations.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• Proficient computer skills including working knowledge of Microsoft Office.
• Analytical, interpretive, and critical thinking skills.
• Ability to manage ambiguity.
• Strong organizational and multitasking skills.
• Ability to work in a team environment.
• Ability to meet or exceed performance competencies as required by program.
• Effective decision-making and negotiation skills.
• Ability to exercise judgement autonomously within established procedures.

Responsibilities

• Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation.
• Determines benefits due and makes timely payments/approvals and adjustments.
• Medically manages disability claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Coordinates investigative efforts and thoroughly reviews contested claims.
• Negotiates return to work with or without job accommodations.
• Evaluates and arranges appropriate referral of claims to outside vendors.
• Makes independent claim determinations to approve or deny complex disability claims.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Utilizes appropriate clinical resources in case assessment.
• Informs claimants of documentation required to process claims and communicates claims status.
• Communicates with the claimants’ providers regarding return to work expectations.
• Maintains professional client relationships and provides excellent customer service.
• Meets the organization’s quality program(s) minimum requirements.

Benefits

• Caring culture and work-life balance.
• Opportunities for career growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees