Disability Representative, Senior
Sedgwickcms - Chicago, IL

This job posting is no longer available on Sedgwick Claims Management Services. Find similar jobs: Disability Representative jobs - Sedgwickcms jobs

Disability Representative Sr

CLAIM 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 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 RESPONSIBILITIES

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

    Education & Licensing
    Baccalaureate from an accredited university or college preferred.

    Experience
    Two (2) years benefits or disability claims management 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

    Additional Information:
    N/A

    Sedgwick Claims Management Services - 20 months ago - save job - copy to clipboard
    Recommended Jobs
    Director of Income Development and Marketing...
    Susan G. Komen for the Cure - Chicago, IL
    Susan G. Komen for the Cure - 1 day ago
    Easily apply

    Sr Manager Truckload Operations
    AIT Worldwide Logistics, Inc. - Chicago, IL
    AIT Worldwide Logistics, Inc. - 5 days ago

    Senior Territory Business Manager - Immunosci...
    Bristol-Myers Squibb - Chicago, IL
    Bristol-Myers Squibb - 7 days ago
    About this company
    186 reviews
    Unlike Kyra, this Sedgwick probably can't play the "Six Degrees of Kevin Bacon" game, but it can help employers save a little...