Disability Representative

Sedgwick Claims Management Services Ltd; Cedar Rapids (IA); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Sedgwick Claims Management Services Ltd in Cedar Rapids, IA is seeking a Disability Representative to support disability claims processing and related activities. You will analyze medical documentation, determine benefits, and coordinate return-to-work and referrals, while maintaining client relationships.

The role emphasizes collaboration, accuracy, and adherence to disability plans and regulatory guidelines within a hybrid work environment.

Qualifications

• Excellent oral and written communication skills.
• Proficient with Microsoft Office and standard office software.
• Strong analytical, interpretive and critical thinking abilities.
• Solid organizational and multitasking capabilities.
• Ability to work effectively in a collaborative team environment.
• Decision making and negotiation skills with limited supervision.

Responsibilities

• Provides disability case management and routine claim determinations based on medical documentation.
• Reviews medical information, determines benefits due, and ensures timely payments/adjustments.
• Coordinates return-to-work efforts and referrals to outside vendors or physician reviews.
• Maintains client relationships and adheres to quality programs.

Skills

Communication

Computer skills

Analytical thinking

Organizational skills

Teamwork

Negotiation

Judgement

Education

High school diploma or GED

Job description

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 Cedar Rapids, IA 333 1st Street SE Ste.200 Cedar Rapids IA 52401

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

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.

ESSENTIAL FUNCTIONS and 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

QUALIFICATIONS

• 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 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.

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Physical: Ability to sit at a desk for extended periods while operating a computer and phone system.

Travel as required.

Auditory/Visual: Hearing, vision and talking.

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com