Workforce Absence Care Team Representative
Company: Sedgwick Claims Management Services, Inc.
Location: New Albany
Posted on: January 16, 2022
The 'Apply with SEEK' option will be utilized for International
applicants, mainly Australia. If this does not apply to you please
use the 'Apply' option.
Workforce Absence 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 27,000 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.
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
* 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
* 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
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
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
Keywords: Sedgwick Claims Management Services, Inc., Columbus , Workforce Absence Care Team Representative, Other , New Albany, Ohio
Didn't find what you're looking for? Search again!