Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

　　A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

　　Great Place to Work®

　　Most Loved Workplace®

　　Forbes Best-in-State Employer

　　Workforce Absence Care Team Representative

　　PRIMARY PURPOSE : To actively research, resolve, and administer escalated inquires for all lines of business including but not limited to FMLA, Accommodations, and disability claims; and to execute technical and jurisdictional requirements for accurate claims processing, benefit review and interpretation of regulations, financial payment processing, and error correction of complex or high exposure claims.

　　ESSENTIAL FUNCTIONS and RESPONSIBILITIES

　　Analyzes and authorizes claims and determines benefits due pursuant to a plan.

　　Enters and adjusts payments and evaluates file interface to support payment research and resolution.

　　Communicates clearly with claimant and client on all aspects of the claims process including: claim approval, decision authority level to move the call forward, and issue resolution.

　　Facilitates claim resolution with claimant, human resources managers, treating physician’s office, client, or other callers.

　　Ensures claims files are coded correctly and that adequate documentation is in the claim.

　　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 and take all necessary action to manage claims process to completion.     

　　Informs claimants and client of documentation required to process claims, required timeframes, payment information and claims status.     

　　Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

　　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 college or university preferred.

　　Experience

　　Three (3) years of related experience or equivalent combination of experience and education required to include two (2) years of disability claims experience. Experience with TAMS, Juris, SMART, SIR, viaOne express, GAIN, or other HR system preferred.

　　Skills & Knowledge

　　Knowledge of ERISA regulations, FMLA, ADAAA, disability procedures and basic clinical terminology.

　　Excellent oral and written communication skills

　　PC literate, including Microsoft Office products

　　Analytical and interpretive skills

　　Excellent interpersonal skills

　　Strong organizational skills

　　Ability to work in a team environment

　　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

　　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.

　　If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

　　Taking care of people is at the heart of everything we do. Caring counts

　　Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)