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30Sep

Sr. Clams Representative - Disability

Sedgwick, Dubuque, IA Dubuque, IA

This listing has expired

Disability Representative Sr

 

PRIMARY PURPOSE: To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.
  • 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.
  • Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).
  • Communicates with the claimants providers to set expectations regarding return to work.
  • Determines benefits due, makes timely claims payments/approvals 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 physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
  • Negotiates return to work with our without job accommodations via the claimants physician and employer.
  • Refers cases as appropriate to supervisor and management.
  • Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited university or college preferred.

Experience
Three (3) years of benefits or disability claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

  • Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Ability to work in a team environment
  • Excellent negotiation skills
  • Ability to meet or exceed Performance Competencies

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: Computer keyboarding, 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

This listing has expired

Job Details

Req Num --
ID 758548
Location
Dubuque, IA
Dubuque, IA
Positions 3
Type
Employee
Status
Full Time
Pay --
Categories
Health Care
Insurance
EMSI Skills Case Management
Communications
Coordinating
Employee Retirement Income Security Act
Management
Medical Management
Microsoft Office
Negotiation
Organizational Skills
Presentations
Social Security
Social Security Disability Insurance
Teamwork
Workers' Compensation
Written Communication
Shifts
First Shift
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Retirement Plan
Paid Vacation
Paid Sick Leave
Paid Holidays
Tuition Reimbursement

Preferred Candidates

Years of Experience 2-5 Years
Education Associates

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