Disability Representative

Overview

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. 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. This role is for a Disability Representative and is based near one of our Centers of Excellence in Cedar Rapids, IA : 333 1st Street SE Ste.
200 Cedar Rapids IA 52401.

What we offer:

• A stable, consistent work environment – both in-office and virtual
• A comprehensive training program to help you support employees and customers from some of the world's most respected brands
• A dedicated mentor and manager to guide you every step of your career journey
• Career development and promotional opportunities as you take on new responsibilities
• A diverse, all-inclusive benefits package designed to support your mental, physical, financial, and professional well-being

Your next big opportunity starts here—are you ready to join us?

We are looking for enthusiastic and empathetic candidates that want to grow a career. Ideal candidates will thrive in a collaborative team environment, show motivation and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused.

Primary purpose: Provides disability case management and routine 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; coordinates investigative efforts, reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.

• Makes claim determinations, based on information received, to approve routine disability claims or recommends denial to the team lead based on the disability plan.
• Reviews and analyzes routine medical information (e.g., attending physical statements, office notes, off-work notes) or consults with a nurse to determine if the claimant is disabled as defined by the disability plan.
• Utilizes appropriate clinical resources in case assessment (e.g., duration guidelines, in-house clinicians).
• Determines benefits due, makes timely claims payments and adjustments for workers compensation, SSDI, and other disability offsets.
• Informs claimants of required documentation, 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 routine disability claims ensuring compliance with duration control guidelines and plan provisions.
• Communicates clearly and timely with claimants and clients on all aspects of the 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 referrals to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and related disability activities.
• Negotiates return to work with or without job accommodations via the claimant s physician and employer.
• Refers cases as appropriate to team lead and clinical case management to assist with claim determinations.
• Meets the organization s quality program minimum requirements.
• Maintains professional client relationships and provides excellent customer service.

• Performs other duties as assigned.

High school diploma or GED required.

Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of office or customer service experience required. One (1) year of benefits or claims management experience preferred.

• Knowledge of ERISA regulations, required 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 working knowledge of Microsoft Office
• Analytical, interpretive, and critical thinking skills
• 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 judgment with limited supervision

When applicable and appropriate,…