Disability Representative

Sedgwick•Dubuque, IA

6d•Hybrid

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 Disability Representative Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near one of our dynamic Centers of Excellence📍 Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002 ✨ What we offer: A stable, consistent work environment—both in-office and virtual A comprehensive training program to help you support employees and customers from some of the world’s most respected brands A dedicated mentor and manager to guide you every step of your career journey Career development and promotional opportunities as you take on new responsibilities A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being Your next big opportunity starts here—are you ready to join us? ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic and empathetic candidates that want to grow a career. Ideal candidates will thrive in a collaborative team environment, show motivation, and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused. PRIMARY PURPOSE: Provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinates investigative efforts, thoroughly reviewing contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.

Requirements

High school diploma or GED required.
Two (2) years of related experience or equivalent combination of education and experience required.
One (1) year of office or customer service experience required.
Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
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
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 with limited supervision

Nice To Haves

One (1) year of benefits or claims management experience preferred.

Responsibilities

Makes claim determinations, based on the information received, to approve routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
Reviews and analyzes routine medical information (i.e. attending physical statements, office notes, off work notes, etc.) or consults with a nurse 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) regularly.
Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.
Communicates with the claimants’ providers to set expectations regarding return to work.
Medically manages routine disability claims ensuring compliance with duration control guidelines and plan provisions.
Communicates clearly and timely with claimant and client on all aspects of claims process 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 claimant’s physician and employer.
Refers cases as appropriate to team lead and clinical case management to assist with claim determination.
Meets the organization’s quality program(s) minimum requirements.
Maintains professional client relationships and provides excellent customer service.
Performs other duties as assigned.

Benefits

A stable, consistent work environment—both in-office and virtual
A comprehensive training program to help you support employees and customers from some of the world’s most respected brands
A dedicated mentor and manager to guide you every step of your career journey
Career development and promotional opportunities as you take on new responsibilities
A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being
Entry-level colleagues are offered a world class training program with a comprehensive curriculum.
An assigned mentor and manager that will support and guide you on your career journey.
Career development and promotional growth opportunities
A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more.

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