Sedgwick
Overview
Join to apply for the Disability Representative Sr role at Sedgwick. Sedgwick is a global provider of risk, health, life, and integrated insurance solutions. In France, Sedgwick offers insurance expertise to respond to market needs and client demands. Our values are Empathy, Responsibility, Collaboration, Growth and Integration. Disability Representative Sr Primary Purpose
Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments. Medically manages disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, reviews contested claims, negotiates return to work with or without job accommodations, and arranges appropriate referral of claims to outside vendors. Essential Functions and Responsibilities
Makes independent claim determinations, based on the information received, to approve complex disability claims or recommends denial to the team lead based on the disability plan. Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan. Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. Utilizes appropriate clinical resources in case assessment (e.g., duration guidelines, in-house clinicians) as needed. Determines benefits due pursuant to a disability plan and makes timely payments/approvals and adjustments for workers compensation, SSDI, and other disability offsets. Informs claimants of documentation required, time frames, payment information and claims status by phone, written correspondence and/or claims system. Communicates with claimants’ providers to set expectations regarding return to work. Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions. Communicates clearly and timely with claimant and client on all aspects of the claims process by phone, written correspondence and/or claims system. Coordinates investigative efforts ensuring appropriateness; reviews contested claims thoroughly. Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluations, functional capacity evaluations, and related activities. Negotiates return to work with or without job accommodations via the claimant’s physician and employer. Refers cases to team lead and clinical case management for additional review when appropriate. Maintains professional client relationships and provides excellent customer service. Meets the organization’s quality program minimum requirements. Additional Functions and Responsibilities
Performs other duties as assigned. Qualifications
Education & Licensing
High School diploma or GED required. Bachelor’s degree preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations. Experience
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. Skills & Knowledge
Knowledge of ERISA regulations, 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 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 Ability to exercise judgement autonomously within established procedures Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; good judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities and 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. Compensation & Equal Opportunity
Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. The starting pay range for this role in the noted jurisdiction is $17.45 - $22.45. A comprehensive benefits package is offered including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits. The statements describe the general nature and level of work being performed and are not intended to be a comprehensive list of functions. Management may change duties at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Si ce poste vous intéresse mais que votre expérience ne correspond pas parfaitement à toutes les qualifications, envisagez de postuler quand même. Sedgwick promeut un lieu de travail diversifié, équitable et inclusif. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries Insurance
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Join to apply for the Disability Representative Sr role at Sedgwick. Sedgwick is a global provider of risk, health, life, and integrated insurance solutions. In France, Sedgwick offers insurance expertise to respond to market needs and client demands. Our values are Empathy, Responsibility, Collaboration, Growth and Integration. Disability Representative Sr Primary Purpose
Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments. Medically manages disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, reviews contested claims, negotiates return to work with or without job accommodations, and arranges appropriate referral of claims to outside vendors. Essential Functions and Responsibilities
Makes independent claim determinations, based on the information received, to approve complex disability claims or recommends denial to the team lead based on the disability plan. Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan. Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. Utilizes appropriate clinical resources in case assessment (e.g., duration guidelines, in-house clinicians) as needed. Determines benefits due pursuant to a disability plan and makes timely payments/approvals and adjustments for workers compensation, SSDI, and other disability offsets. Informs claimants of documentation required, time frames, payment information and claims status by phone, written correspondence and/or claims system. Communicates with claimants’ providers to set expectations regarding return to work. Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions. Communicates clearly and timely with claimant and client on all aspects of the claims process by phone, written correspondence and/or claims system. Coordinates investigative efforts ensuring appropriateness; reviews contested claims thoroughly. Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluations, functional capacity evaluations, and related activities. Negotiates return to work with or without job accommodations via the claimant’s physician and employer. Refers cases to team lead and clinical case management for additional review when appropriate. Maintains professional client relationships and provides excellent customer service. Meets the organization’s quality program minimum requirements. Additional Functions and Responsibilities
Performs other duties as assigned. Qualifications
Education & Licensing
High School diploma or GED required. Bachelor’s degree preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations. Experience
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. Skills & Knowledge
Knowledge of ERISA regulations, 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 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 Ability to exercise judgement autonomously within established procedures Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; good judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities and 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. Compensation & Equal Opportunity
Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. The starting pay range for this role in the noted jurisdiction is $17.45 - $22.45. A comprehensive benefits package is offered including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits. The statements describe the general nature and level of work being performed and are not intended to be a comprehensive list of functions. Management may change duties at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Si ce poste vous intéresse mais que votre expérience ne correspond pas parfaitement à toutes les qualifications, envisagez de postuler quand même. Sedgwick promeut un lieu de travail diversifié, équitable et inclusif. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries Insurance
#J-18808-Ljbffr