Sedgwick
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Disability Representative Sr.
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Sedgwick 2 days ago Be among the first 25 applicants Join to apply for the
Disability Representative Sr.
role at
Sedgwick Get AI-powered advice on this job and more exclusive features. 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.
Our Teams Connect! We Collaborate Onsite And Have a Hybrid Work Arrangement. All Candidates Must Live Near One Of Our Centers Of Excellence
Dubuque, IA
: 4141 Westmark Drive, Dubuque, IA 52002
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
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
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.
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 $20.39 - $22.50 USD Hourly. 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.
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Other Industries Insurance Referrals increase your chances of interviewing at Sedgwick by 2x Sign in to set job alerts for “Senior Representative” roles.
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Disability Representative Sr.
role at
Sedgwick 2 days ago Be among the first 25 applicants Join to apply for the
Disability Representative Sr.
role at
Sedgwick Get AI-powered advice on this job and more exclusive features. 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.
Our Teams Connect! We Collaborate Onsite And Have a Hybrid Work Arrangement. All Candidates Must Live Near One Of Our Centers Of Excellence
Dubuque, IA
: 4141 Westmark Drive, Dubuque, IA 52002
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
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
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.
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 $20.39 - $22.50 USD Hourly. 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.
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Other Industries Insurance Referrals increase your chances of interviewing at Sedgwick by 2x Sign in to set job alerts for “Senior Representative” roles.
Customer Service Representative - State Farm Agent Team Member
Chicago, IL $61,000.00-$65,000.00 2 weeks ago Customer Service Representative (Chicago)- $20.25 per hour
Chicago, IL $70,000.00-$80,000.00 3 weeks ago Chicago, IL $54,500.00-$71,040.00 4 days ago Customer Service Representative - State Farm Agent Team Member
Berwyn, IL $55,000.00-$75,000.00 8 months ago Account Manager (Remote) - Water treatment chemical Sales
Elk Grove Village, IL $110,000.00-$150,000.00 2 days ago Lisle, IL $70,000.00-$80,000.00 1 month ago Customer Service Representative - State Farm Agent Team Member
Mount Prospect, IL $17.00-$19.00 2 weeks ago Senior Cost Manager (Owner's Representative)
Chicago, IL $130,000.00-$150,000.00 4 weeks ago Future Opportunity - Direct Territory Manager
Billing and Reimbursement Customer Service Representative
Chicago, IL $45,000.00-$50,000.00 2 weeks ago Customer Service Representative - State Farm Agent Team Member
Customer Success Lead, Strategic Accounts
Chicago, IL $115,000.00-$140,000.00 2 weeks ago Oak Park, IL $45,000.00-$50,000.00 2 weeks ago Customer Support Specialist (US - Remote)
Customer Experience Representative, Advanced Services
Customer Service Representative (Suburbs)- $20.25 per hour
Elmhurst, IL $45,000.00-$50,000.00 2 weeks ago Customer Relations Representative - State Farm Agent Team Member
Glenview, IL $40,000.00-$45,000.00 10 months ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr