Return to Work Representative

Sedgwick Claims Management Services Ltd; Los Angeles, Fallbrook (CA, CA); On-site; USD 37,000 - 51,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k and matching

PTO

Life Insurance

Flexible spending account

Job summary

Sedgwick is hiring for a Return-to-Work Representative in Los Angeles. This role negotiates and monitors successful RTW for claimants, supports case management decisions, and ensures regulatory compliance in communications and reporting.

You will engage with employers, providers, and claimants to determine job functions, determine accommodations, and maintain ongoing client contact to guide case progression.

Qualifications

• Education & Licensing: HS Diploma/GED required. Bachelor's degree from an accredited college or university preferred.
• Experience: 3 years of related experience including 1 year of return-to-work or job accommodation experience or 3 years of claims management experience or equivalent.
• Skills & Knowledge: Strong negotiation, communications, and documentation abilities; proficient with Microsoft Office; analytical and organizational skills.

Responsibilities

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.
• Facilitates return-to-work and accommodation efforts through negotiation with client, treatment provider and claimant; documents related reporting to standards.
• Contacts employers to gather information on employment area and job requirements; recommends adaptive equipment as needed.
• Maintains regular contact with clients post-placement and supports transitions from medical case management to job placement.
• Performs other duties related to accommodation/RTW evaluation and work adjustment.

Skills

Negotiation

Verbal & written communication

Analytical skills

Teamwork

Microsoft Office

Documentation

Education

HS Diploma/GED

Bachelor's degree preferred

Tools

Claims management software

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 Return to Work Representative

PRIMARY PURPOSE:

To negotiate, facilitate and monitor successful return-to-work of claimants within appropriate disability duration guidelines and to assist case management staff with client competence decisions for individual positions.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.
• Facilitates return-to-work (RTW) and accommodation efforts through negotiation with client, treatment provider and claimant; completes all accommodation/RTW related jurisdictional or client directed documentation, notification, or reporting; and documents client contact in claim notes as per Sedgwick CMS standards.
• Adheres to medical and legal regulations and accreditation standards in written communication.
• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc.); ascertains the specific physical tolerances, vocational skills and essential job functions needed for specific employment positions as requested by referral sources or employers; and recommends necessary adaptive equipment as needed.
• Maintains regular contact with clients following placement as per program guidelines, contacts involved individuals regarding progress on each case and makes suggestions as needed for changing plans.
• Works closely with team members to ensure smooth transition from medical case management into job placement.
• Performs other tasks related to accommodation/RTW evaluation and work adjustment as needed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

• Education & Licensing: HS Diploma/GED required. Bachelor's degree from an accredited college or university preferred.
• Experience: Three (3) years of related experience including one (1) year of return-to-work or job accommodation experience or three (3) years of claims management experience or equivalent combination of education and experience required.
• Skills & Knowledge: Working knowledge of return-to work or job accommodation procedures Good technical knowledge of claims management procedures Excellent oral and written communications, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation skills Ability to work in a team environment 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

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 $26.55 - $37.18 USD Hourly.

BENEFITS

• 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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

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.

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