Senior Disability Claims Specialist

NADR; Cedar Rapids (IA); Presencial; USD 29.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental benefits

Vision benefits

401k with company match

PTO

Descripción de la vacante

Sedgwick is hiring for a Disability Representative Sr in Cedar Rapids, IA. In this role you will provide disability case management and make complex claim determinations based on medical documentation and plan interpretation, including calculating benefits and arranging timely payments.

You will review medical information, coordinate investigations, manage ADA accommodations, and negotiate return to work with healthcare providers and employers while maintaining quality client relationships and

Formación

• High School diploma or GED required.
• Bachelor’s degree from an accredited university or college preferred.
• State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• 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.
• Ability to manage ambiguity.
• 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.

Responsabilidades

• Makes independent claim determinations and approves complex disability claims or recommends denial.
• Reviews complex medical information to determine disability status.
• Oversees complex claims including comorbidities, concurrent plans and ADA accommodations.
• Utilizes clinical resources for case assessment as needed.
• Determines benefits due and makes timely payments and adjustments.
• Informs claimants of required documentation and processing timelines.
• Communicates with claimants and providers about return to work.
• Medically manages complex disability claims ensuring adherence to guidelines.
• Coordinates referrals to outside vendors or physician reviews as needed.
• Negotiates return to work with or without accommodations.
• Refers cases for additional review when appropriate.
• Maintains professional client relationships and quality standards.

Conocimientos

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Decision making

Negotiation skills

Teamwork

Judgement under uncertainty

Educación

High School diploma or GED

Bachelor’s degree preferred

State certification/licensing in statutory leaves (preferred)

Herramientas

Microsoft Office

Descripción del empleo

Sedgwick is hiring for a Disability Representative Sr in Cedar Rapids, IA. In this role you will provide disability case management and make complex claim determinations based on medical documentation and plan interpretation, including calculating benefits and arranging timely payments.

You will review medical information, coordinate investigations, manage ADA accommodations, and negotiate return to work with healthcare providers and employers while maintaining quality client relationships and