Workforce Absence Care Team Representative **Sedgwick** 1 Positions ID: R58300 Posted On 02/11/2025 **Job Overview** 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 Workforce Absence Care Team Representative **PRIMARY PURPOSE** **:** Actively researches, resolves, and administers escalated inquires for all lines of business, including but not limited to Family Medical Leave (FMLA), complex paid and unpaid state, military, and company-specific leaves, accommodations, disability and statutory claims. Provides excellent customer service displaying care and empathy to callers regarding claims and executes technical and jurisdictional requirements for accurate claims processing, benefit review and interpretation of regulations, financial payment processing, and error correction of complex or high exposure claims. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Makes independent claim determinations, based on the information received, to approve complex claims or make a recommendation to team lead to deny claims based on the requirements. + Analyzes and authorizes leave, accommodation, disability, and statutory claims and determines benefits due pursuant to client plans, and state and federal regulations. + Enters and adjusts payments and evaluates file interface to support payment research and resolution. + Communicates clearly and professionally with claimant and client on all aspects of the claims process including claim approval, decision authority level to move the call forward, and issue resolution by phone, written correspondence and/or claims system. + Facilitates claim resolution and handles escalated calls with claimant, human resources managers, treating physician’s office, client, or others with a goal of one-call resolution. + Ensures claims files are coded correctly and that adequate documentation is in the claim. + 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 and takes all necessary action to manage claims process to completion.  + Informs claimants and client of documentation required to process claims, required timeframes, payment information and claims status.  + Determines benefits due, makes timely and accurate claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. + Maintains professional client relationships and adheres to client specific requirements such as service level expectations, regulatory requirements, and reporting. + 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 college or university preferred. **Experience** Three (3) years of related experience or equivalent combination of experience and education required to include two (2) years of disability claims experience. Experience with SMART, SIR, GAIN, or other HR systems preferred. Experience with TAMS, Juris, viaOne express, and mySedgwick preferred for internal candidates. **Skills & Knowledge** + Knowledge of ERISA regulations, state and federal FMLA, ADAAA, Social Security application procedures, required offsets and deductions, and disability procedures + Working knowledge of medical terminology and duration management + Proficient computer skills including working knowledge of Microsoft Office + Exemplary call handling and de-escalation skills + Excellent interpersonal communication skills, oral and written + Analytical, interpretive, and critical thinking skills + Effective decision-making + Ability to manage ambiguity + Strong organizational and multitasking skills + Ability to exercise judgement autonomously within established procedures + Ability to work in a team environment + Ability to meet or exceed performance competencies as required by program **WORK ENVIRONMENT** Required to adhere to a set schedule with established break times. 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 **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.** Primary Contact 1645458383738 Amanda Strothman , Phone Phone Phone Fax amanda.strothman@sedgwick.com Email True False True **Job Details** Categories Insurance Technical Location Dubuque, IA Job Type Employee Full/Part Full Time Company ID 8326 Job REQ # R58300 \# Positions 1 Start Date 20250211 End Date 20250315 Featured Job TH Ad TH Comments **Similar Jobs** Client Service Representative (CSR) Kunkel & Associates, Inc. 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These needs are filled either through Sedgwick CMS University and through industry certification programs and other external educational resources . Sedgwick CMS University curriculum offerings take colleagues from orientation to technical training to supervisory and managerial development. Through Sedgwick CMS University, we provide our colleagues continuous development of professional skills and the ability to deliver quality service to our clients. **Colleague Orientation** We offer a required colleague orientation program that allows us to verify and document the training provided to new colleagues. This program is called Personal Responsibility in Developing Excellence (PRIDE) and is the first component of our comprehensive career development process. This program introduces and orients new and transitioning colleagues to our company and to their new position. PRIDE will take colleagues through the first 90 days of their new position. Objectives of this program focus on providing colleagues an increased awareness of who we are, where we are going, and how they can help us get there. **Career Paths** Career path options are identified through an ongoing process of discussion and collaboration between colleagues and their managers. On an ongoing basis, our managers counsel colleagues regarding their career path, new opportunities, and additional training and development requirements to help them reach their individual goals.