Disability Representative Sr

Sedgwick•Dublin, OH

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 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.

Requirements

Bachelor's degree from an accredited university or college preferred.
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required.
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 management
Excellent oral and written communication, including presentation skills
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

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 plan.
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 management.
Maintains professional client relationships.
Performs other duties as assigned.
Supports the organization's quality program(s).