Disability Representative

Sedgwick Claims Management Services • Fallbrook, CA

72d • $19 - $23 • 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. Our teams connect! We collaborate in office and have a hybrid work arrangement. All candidates must live near our West Hills, CA center of excellence. Are you looking for an impactful job that offers the opportunity to develop a professional career? Bring your 1-2 years' experience in an office setting and grow with us! A stable and consistent work environment in an office and/or virtual setting, a training program to learn how to help employees and customers from some of the world's most reputable brands, an assigned mentor and manager who will guide you on your career journey, and career development and promotional growth opportunities through increasing responsibilities await you.

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.
• One (1) year of benefits or claims management 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 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.
• Effective decision-making and negotiation skills.
• Ability to exercise judgement with limited supervision.

Responsibilities

• Provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation.
• Makes claim determinations to approve routine disability claims or recommends denial based on the disability plan.
• Reviews and analyzes routine medical information to determine if the claimant is disabled as defined by the disability plan.
• Utilizes appropriate clinical resources in case assessment.
• Determines benefits due and makes timely claims payments and adjustments.
• Informs claimants of documentation required to process claims and claims status.
• Communicates with claimants' providers regarding return to work expectations.
• Medically manages routine disability claims ensuring compliance with duration control guidelines.
• Coordinates investigative efforts and provides thorough review of contested claims.
• Evaluates and arranges appropriate referral of claims to outside vendors.
• Negotiates return to work with or without job accommodations.
• Refers cases as appropriate to team lead and clinical case management.
• Maintains professional client relationships and provides excellent customer service.

Benefits

• Comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees