Disability Claims Specialist III - Delta

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CLAIM YOUR FUTURE AS A GREAT PERFORMER!


Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been recently voted the Best TPA in America and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE: To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan. Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. Refers cases as appropriate to supervisor and management. Negotiates settlement of claims up to designated authority level. Maintains professional client relationships. Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.
REQUIREMENTS


Education & Licensing:

Baccalaureate degree from an accredited college or university in nursing, social work or vocational rehabilitation is preferred

At least one of the following licenses is required: RN, LVN, CRC, COHN, CVE, LPC or LCSW.


Experience: Three (3) years benefits or disability claims management experience required.


Skills & Knowledge: Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures. Excellent oral and written communication, including presentation skills. PC literate, including Microsoft Office products. Analytical and interpretive skills. Strong organizational skills. Ability to work in a team environment. Excellent negotiation skills. Ability to meet or exceed Performance Competencies.

Sedgwick CMS is an Equal Opportunity Employer