Absence Management Care Team Representative
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For 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 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).
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
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
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
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