Sr. Claims Representative (Disability)
Company: Sedgwick Claims Management Services, Inc
Location: Irving
Posted on: January 12, 2021
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Job Description:
Disability Representative SrWe have openings in both our Irving
and Plano locations. Please specify your preferred location on your
application or if you are open to either. IF YOU CARE, THERE'S A
PLACE FOR YOU HEREFor a career path that is both challenging and
rewarding, join Sedgwick's talented team of 21,000 colleagues
around the globe. Sedgwick is a leading provider of
technology-enabled risk, benefits and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. Whether they have a workplace
injury, suffer property or financial loss or damage from a natural
or manmade disaster, are involved in an auto or other type of
accident, or need time away from work for the birth of a child or
another medical situation, we are here to provide compassionate
care and expert guidance. Our clients depend on our talented
colleagues to take care of their most valuable assets -- their
employees, their customers and their property. At Sedgwick, caring
counts--. Join our team of creative and caring people of all
backgrounds, and help us make a difference in the lives of
others.As the largest provider of disability and absence management
solutions, Sedgwick offers a combination of services covering every
possible time away from work scenario. Our clients depend on us to
support and improve the health and productivity of their workforce
in a way that is cost-effective, efficient and compliant.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).QUALIFICATIONSEducation & LicensingBachelor's degree
from an accredited university or college preferred.ExperienceThree
(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 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#LI-TS
Keywords: Sedgwick Claims Management Services, Inc, Irving , Sr. Claims Representative (Disability), Other , Irving, Texas
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