Disability Representative, Senior

Mô tả công việc

Disability Representative SrCLAIM YOUR FUTURE AS A GREAT PERFORMER!Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, “Claim Your Future.” PRIMARY PURPOSE: To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level.ESSENTIAL FUNCTIONS and RESPONSIBILITIES  Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.Determines benefits due, makes timely claims payments 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 for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.Refers cases as appropriate to supervisor and management.Negotiates settlement of claims up to designated authority level.Maintains professional client relationships.ADDITIONAL FUNCTIONS and RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).QUALIFICATIONSEducation & LicensingBaccalaureate from an accredited university or college preferred.ExperienceTwo (2) years benefits or disability claims management experience or successful completion of Disability Representative training required.Skills & KnowledgeKnowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application proceduresExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsAbility to work in a team environmentExcellent negotiation skillsAbility to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen 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 deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingNOTE: 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 Employerand aDrug-Free Workplace