Disability Representative

Disability Representative

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

Our teams connect! We collaborate in-office and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:

Cedar Rapids, IA: 333 1st Street SE Ste. 200 Cedar Rapids IA 52401

Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241

Dublin, OH: 5500 Glendon Court Dublin OH 43016

New Albany, OH: 7795 Walton Parkway New Albany, OH 43054

Chicago, IL: 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604

Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268

Irving, TX: 2201 W. Royal Lane Suite 125 Irving, TX 75063

Memphis, TN: 8125 Sedgwick Way, Memphis TN 38125

Southfield, MI: 300 Galleria Officentre Southfield MI 48034

Orlando, FL: 12650 Ingenuity Dr Orlando FL 32826

Eden Prairie, MN: 11000 Prairie Lakes Drive Eden Prairie, MN 55344 Dubuque, IA: 4141 Westmark Drive, Dubuque, IA 52002

Are you looking for an impactful job requiring that offers an opportunity to develop a professional career? Bring your 2+ years' experience in an office setting or medical experience and grow with us!

• A stable and consistent work environment in an office and/or virtual setting
• A training program to learn how to help employees and customers from some of the world's most reputable brands.
• An assigned mentor and manager who will guide you on your career journey.
• Career development and promotional growth opportunities through increasing responsibilities
• A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs.

PRIMARY PURPOSE: Provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinates investigative efforts, thoroughly reviewing contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic and empathetic candidates that want to grow a career. Ideal candidates will thrive in a collaborative team environment, show motivation, and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Makes claim determinations, based on the information received, to approve routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
• Reviews and analyzes routine medical information (i.e. attending physical statements, office notes, off work notes, etc.) or consults with a nurse 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) regularly.
• Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
• Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.
• Communicates with the claimants' providers to set expectations regarding return to work.
• Medically manages routine disability claims ensuring compliance with duration control guidelines and plan provisions.
• Communicates clearly and timely with claimant and client on all aspects of claims process 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 claimant's physician and employer.
• Refers cases as appropriate to team lead and clinical case management to assist with claim determination.
• Meets the organization's quality program(s) minimum requirements.
• Maintains professional client relationships and provides excellent customer service.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing High school diploma or GED required.

Experience Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of office or customer service experience required. One (1) year of benefits or claims management experience preferred.

Skills & Knowledge 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

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Ability to sit at a desk for extended periods while operating a computer and phone system. 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.

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.