Job Description
By joining Sedgwick , you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Sr. Disability Representative- FR/ENG Bilingual PRIMARY PURPOSE : To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes,approvesand authorizes assigned claims anddeterminesbenefits duepursuant toa disability plan. Reviews and analyzes complex medical information (i.e.diagnostic tests, office notes, operative reports, etc.) todetermineif the claimant is disabled as defined by the disability plan. Utilizes theappropriate clinicalresources in case assessment (i.e.duration guidelines, in-house clinicians). Communicates with theclaimant’sproviders to set expectationsregardingreturn to work. Determinesbenefits due, makestimelyclaims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. Medically manages disabilityclaimsensuring compliance with duration control guidelines and plan provisions. Communicates clearly with claimant and client on all aspects of claims process either by phoneand/or written correspondence. Info
