Disability Representative

Sedgwick; Dubuque (IA); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Structured training program

Mentor and manager guidance

Career development opportunities

Comprehensive benefits package

Job summary

Sedgwick in Dubuque, IA is seeking a Disability Representative to provide disability case management and routine claim determinations based on medical documentation and plan interpretation. You will coordinate benefits, make timely payments, and negotiate return-to-work with employers and physicians in a hybrid work environment near Dubuque.

The role emphasizes accurate claims processing, strong communication with claimants and providers, and adherence to ERISA and FMLA guidelines, while

Qualifications

• 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

Responsibilities

• Makes claim determinations and recommends denial or approval based on disability plan
• Reviews medical information and consults with a nurse to determine disability status
• Determines benefits due and processes timely payments and adjustments
• Negotiates return to work with or without accommodations with claimant’s physician and employer

Skills

ERISA knowledge

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Team oriented

Decision making

Judgement under supervision

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Dubuque, IA

Full time

R69627

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.

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

Education & Licensing

High school diploma or GED required.

Experience

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.

Skills & Knowledge

• 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

TAKING CARE OF YOU

• 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.

NOTE

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

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

#claimsexaminer

#entrylevel

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

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! 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