LTD Case Specialist

Sedgwick•Eden Prairie, MI

18h•$53,000 - $55,000•Onsite

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 PRIMARY PURPOSE: To analyze claims and determine benefits due ensuring compliance with plan provisions; to determine need for outside vendors, surveillance, and/or independent medical evaluations; to negotiate settlements and to make claim payments and revisions within designated authority level; and to calculate and collect overpayments. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes assigned claims and determines benefits due. Informs claimants of documentation required to process their claim and timeframes. Manages claim to ensure compliance with plan provisions. Provides appropriate documentation to LTD Manager for reporting purposes. Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary. Refers cases to LTD Supervisor, LTD Manager, or Project Manager. Negotiates settlement of appropriate claims within designated authority level. Makes claim payments and revisions to benefit amounts. Communicates status on decisions to client, claimant and supervisor. Calculates and collects overpayments. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).

Requirements

Four (4) years of medical disability experience or equivalent combination of education and experience required.
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Nice To Haves

Bachelor's degree from an accredited college or university preferred.
Licenses as required.

Responsibilities

Analyzes assigned claims and determines benefits due.
Informs claimants of documentation required to process their claim and timeframes.
Manages claim to ensure compliance with plan provisions.
Provides appropriate documentation to LTD Manager for reporting purposes.
Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.
Refers cases to LTD Supervisor, LTD Manager, or Project Manager.
Negotiates settlement of appropriate claims within designated authority level.
Makes claim payments and revisions to benefit amounts.
Communicates status on decisions to client, claimant and supervisor.
Calculates and collects overpayments.
Performs other duties as assigned.
Supports the organization's quality program(s).