Disability Representative Sr

Sedgwick Claims Management Services Ltd; Iowa; On-site; USD 30,000 - 33,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401k

PTO

Disability insurance

Life insurance

Employee assistance program

FSA/HSA

Job summary

Sedgwick is seeking a Sr Disability Representative in Iowa to manage disability claims and determine benefits under complex medical documentation and plan rules. You will review medical information, coordinate with providers, negotiate return to work, and ensure timely payments while upholding ERISA compliance and client service standards.

Strong communication, analytical skills and ability to work in a team are essential, with a comprehensive benefits package offered.

Qualifications

• Bachelor's degree preferred.
• Three years of benefits or disability case/claims management experience required.
• Knowledge of ERISA regulations, offsets and deductions, disability duration and SSA processes.
• Excellent written and verbal communication; MS Office proficiency.

Responsibilities

• Analyzes, approves and authorizes assigned claims and determines benefits due.
• Reviews complex medical information to determine disability status.
• Coordinates investigations and referrals to outside vendors or physician reviews.
• Negotiates return to work with or without accommodations.
• Maintains professional client relationships.

Skills

ERISA regulations

Medical terminology

Communication

Microsoft Office

Analytical

Organizational skills

Team environment

Negotiation

Performance competencies

Education

Bachelor's degree

Tools

Microsoft Office

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 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

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

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 pay for this role is $22.00 - $24.00/hr.

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.