Disability Representative Sr

We offer a hybrid work environment with on‑site collaboration. Candidates must be located near our Center of Excellence in Eden Prairie, Minnesota. 11000 Prairie Lakes Drive, Eden Prairie, MN 55344

PRIMARY PURPOSE

Provides disability case management and complex claim determinations based on medical documentation and disability plan interpretation, including determining benefits due and making timely payments, approvals and adjustments. Medically manages disability claims, coordinates investigations, reviews contested claims, negotiates return to work with or without job accommodations, and evaluates referrals to external vendors. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Makes independent claim determinations to approve complex disability claims or recommends denial based on the disability plan. Reviews and analyzes complex medical information to determine claimant disability per the plan. Oversees additional facets of complex claims including comorbidities, concurrent plans, ADA accommodations and claims outside typical guidelines. Utilizes clinical resources in case assessment as needed. Determines benefits due per the plan, makes timely claims payments/approvals and adjustments for workers compensation, SSDI, and other offsets. Informs claimants of required documentation, time frames, payment info and status by phone or written correspondence. Communicates with claimants' providers regarding return to work expectations. Ensures compliance with duration control guidelines and plan provisions. Communicates clearly and promptly with claimant and client by phone, written correspondence or claims system. Coordinates investigative efforts and reviews contested claims. Arranges referrals to outside vendors or specialist reviews. Negotiates return to work with or without job accommodations. Refers cases to team lead and clinical case management when appropriate. Maintains professional client relationships and delivers excellent customer service. Meets the organization’s quality program minimum requirements. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing High School diploma or GED required. Bachelor’s degree from an accredited university or college preferred. State certification or licensing in statutory leaves preferred or may be required. Experience Three (3) years of benefits or disability case/claims management experience or equivalent education and experience preferred. Skills & Knowledge Knowledge of ERISA regulations, 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 and presentation skills. Proficient computer skills, including Microsoft Office. Analytical, interpretive, and critical thinking skills. Ability to manage ambiguity. Strong organization and multitasking skills. Ability to work in a team environment. Ability to meet or exceed performance competencies. Effective decision‑making and negotiation skills. Ability to exercise judgment autonomously within procedures.

WORK ENVIRONMENT

Consideration will be given to reasonable accommodations when applicable. Mental Clear and conceptual thinking ability; excellent judgment; troubleshooting; problem solving; analysis; discretion; handle work‑related stress; manage multiple priorities; meet deadlines. Physical Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required. Auditory/Visual Hearing, vision, and speaking. For the jurisdiction noted in this posting, the starting pay range is $21.00 – $25.00 USD hourly. A comprehensive benefits package is offered including medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. As required by law, Sedgwick provides a reasonable range of compensation for roles hired in jurisdictions requiring pay transparency. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement