Disability Representative Sr

Sedgwick Claims Management Services Ltd; Eden Prairie (MN); Híbrido; USD 34.000 - 44.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

401k with company match

Paid time off

Disability insurance

Descripción de la vacante

Sedgwick is seeking a Disability Representative Sr in Eden Prairie, MN to provide disability case management and determine benefits under complex medical documentation and disability plan interpretation.

You will review medical information, coordinate with providers, negotiate return-to-work accommodations, ensure timely payments, and collaborate with claims teams to support accurate, compliant resolutions.

This role requires strong communication, ERISA knowledge, and careful attention to detail.

Formación

• Knowledge of ERISA regulations, required offsets and deductions.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentations.
• Proficient in Microsoft Office and standard PC use.
• Strong analytical and interpretive abilities for claims review.
• Organized with the ability to manage multiple priorities.
• Collaborative team player with client-focused mindset.
• Excellent negotiation skills for return-to-work discussions.
• Ability to meet performance expectations and competencies.

Responsabilidades

• Analyze, approve and authorize assigned claims and benefits.
• Review complex medical information to determine disability status.
• Coordinate with clinicians and resources for case assessments.
• Communicate with providers to set return-to-work expectations.
• Ensure timely payments and adjustments for various disability offsets.
• Manage claims in accordance with duration guidelines and plan provisions.
• Inform claimants of required documentation and status updates.
• Coordinate referrals to outside vendors or physician reviews.
• Negotiate return-to-work accommodations with physicians and employers.
• Maintain professional client relationships and team collaboration.

Conocimientos

ERISA regulations

Medical terminology

Oral and written communication

PC literate

Analytical skills

Organizational skills

Team environment

Negotiation skills

Performance competencies

Educación

Bachelor's degree

Descripción del empleo

## Disability Representative SrApply: Eden Prairie, MN: Full time: Posted Today: R79129By 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 CompaniesCertified as a Great Place to WorkFortune Best Workplaces in Financial Services & InsuranceDisability Representative Sr**PRIMARY PURPOSE**: To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES*** Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.* Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) 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).* Communicates with the claimants providers to set expectations regarding return to work.* Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.* Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.* Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.* Informs claimants of documentation required to process claims, required time frames, payment information and claims status either 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 claimants physician and employer.* Refers cases as appropriate to team lead and clinical case management.* Maintains professional client relationships. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES*** Performs other duties as assigned.* Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited university or college preferred. **Experience** Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required. **Skills & Knowledge*** Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures* Working knowledge of medical terminology and duration management* Excellent oral and written communication, including presentation skills* PC literate, including Microsoft Office products* Analytical and interpretive skills* Strong organizational skills* Ability to work in a team environment* Excellent negotiation skills* Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking **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. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $25.00 USD hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.