Disability Representative Sr

Sedgwick • Cedar Rapids, IA

276d

About The Position

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

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.
• 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.
• 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.
• Makes independent claim determinations to approve complex disability claims or recommends denial based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Utilizes appropriate clinical resources in case assessment as needed.
• Determines benefits due pursuant to a disability plan and makes timely claims payments/approvals and adjustments.
• Informs claimants of documentation required to process claims, required time frames, payment information and claims status.
• Communicates with the claimants' providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
• Coordinates investigative efforts ensuring appropriateness and provides thorough review of contested claims.
• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews.
• Negotiates return to work with or without job accommodations via the claimant's physician and employer.
• Maintains professional client relationships and provides excellent customer service.
• Meets the organization's quality program(s) minimum requirements.

Benefits

• Flexibility and time for personal priorities.
• Support for mental, physical, financial, and professional needs.
• Opportunities for skill sharpening and career growth.
• Diversity and inclusion in the workplace.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED