Senior Disability Representative

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Provides disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation • Determines benefits due and makes timely payments, approvals, and adjustments • Medically manages disability claims involving comorbidities, concurrent plans, and complex ADA accommodations • Makes independent determinations to approve complex disability claims or recommends denial to the team lead • Reviews and analyzes complex medical information to determine whether claimants are disabled under the disability plan • Utilizes clinical resources in case assessment as needed • Informs claimants about required documentation, deadlines, payment information, and claim status • Communicates with claimants, providers, and clients regarding the claims process and return-to-work expectations • Coordinates investigative efforts and reviews contested claims • Refers claims for vendor services, physician advisor reviews, surveillance, independent medical evaluations, and functional capability evaluations • Negotiates return to work with or without accommodations through the claimant’s physician and employer • Refers cases to team lead and clinical case management for additional review • Maintains professional client relationships and provides customer service • Meets organizational quality program requirements • Performs other duties as assigned

🎯 Requirements

• High School diploma or GED required • Bachelor's degree from an accredited university or college preferred • State certification or licensing in statutory leaves is preferred or may be required based on state regulations • Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and 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 • Ability to manage ambiguity • 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 judgement autonomously within established procedures • Ability to sit at a desk for extended periods while operating a computer and phone system • Travel as required

🏖️ Benefits

• Work-life balance • Reasonable accommodations when applicable and appropriate • Diverse, equitable, and inclusive workplace • Equal Opportunity Employer • Drug-free workplace

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