Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®
Most Loved Workplace® 
Forbes Best-in-State Employer

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 52002Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401Coralville, IA:  3273 Ridgeway Drive Coralville IA 52241Dublin, OH : 5500 Glendon Court Dublin OH 43016New Albany, OH : 7795 Walton Parkway New Albany, OH 43054Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268Irving, TX: 2201 W. Royal Lane Suite 125 Irving, TX 75063Memphis, TN : 8125 Sedgwick Way, Memphis TN 38125Southfield, MI : 300 Galleria Officentre Southfield MI 48034Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826

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 managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates 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 makes a recommendation to team lead to deny claims based on the disability plan.Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) 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 the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals 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 complex 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 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(s) minimum requirements.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing
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.

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, required offsets and deductions, disability duration and medical management practices and Social Security application proceduresKnowledge of state and federal FMLA regulationsWorking knowledge of medical terminology and duration managementExcellent oral and written communication, including presentation skillsProficient computer skills including working knowledge of Microsoft OfficeAnalytical, interpretive, and critical thinking skillsAbility to manage ambiguityStrong organizational and multitasking skillsAbility to work in a team environmentAbility to meet or exceed performance competencies as required by programEffective decision-making and negotiation skillsAbility 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; 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: 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

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.