Hybrid Disability Claims Case Manager

NADR; Dubuque (IA); Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Stable environment

Training program

Mentor support

Career development

Comprehensive benefits

Job summary

Sedgwick in Dubuque, IA is seeking an entry-level Disability Representative to join our team. This role provides disability case management, determines benefits based on medical documentation, and coordinates with providers and clients to ensure timely payments and adjustments.

You will receive comprehensive training, dedicated mentorship, and opportunities for career development in a flexible hybrid work environment near our Center of Excellence.

Qualifications

• 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

Responsibilities

• Makes claim determinations, based on information received, to approve routine disability claims or recommends denial based on the disability plan
• Reviews and analyzes routine medical information or consults with a nurse to determine disability status
• Determines benefits due, makes timely claims payments and adjustments for workers compensation, SSDI, and other disability offsets
• Informs claimants of required documentation and time frames
• Communicates with claimants' providers to set expectations regarding return to work
• Medically manages routine disability claims ensuring compliance with duration guidelines
• Communicates with claimants and clients on all aspects of claims process
• Coordinates investigative efforts ensuring appropriateness and review of contested claims
• Evaluates referrals to outside vendors or physician advisor reviews
• Negotiates return to work with or without job accommodations
• Maintains professional client relationships and provides excellent customer service
• Performs other duties as assigned.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Analytical thinking

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Sedgwick in Dubuque, IA is seeking an entry-level Disability Representative to join our team. This role provides disability case management, determines benefits based on medical documentation, and coordinates with providers and clients to ensure timely payments and adjustments.

You will receive comprehensive training, dedicated mentorship, and opportunities for career development in a flexible hybrid work environment near our Center of Excellence.