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

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PRIMARY PURPOSE:  To process claims and determine accommodation options following written guidelines and procedures pursuant to ADA, state and/or client requirements; to make timely referrals for appropriate disability and federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Informs claimants of documentation required to process claims, required time frames, and claims status either by phone, written correspondence and/or claims system.
• Reviews medical information to determine if the claimant meets the requirements under ADA, state, and/or client requirements for a qualifying condition.
• Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to deny claims based on the ADA, state, and/or client requirements.  Processes ADA claims ensuring compliance with duration control guidelines, ADA and state regulations, and/or client-specific process provisions.
• Determines accommodation options; makes timely claims referrals for appropriate disability or federal/state leave of absence eligibility reviews where applicable.
• Conducts initial employee interview per process guidelines.
• Utilizes the appropriate clinical and vocational resources in case assessment (i.e. duration guidelines, in-house clinicians, ADA job accommodation specialists). 
• Refers cases as appropriate to team lead.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

High school diploma or GED required.

Experience

Two (2) years of related experience or equivalent combination of education and experience required.  One (1) year of benefits or claims management experience preferred.

Skills & Knowledge

• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Good negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

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

NOTE:  Credit security clearance, confirmed via a background credit check, is required for this position.

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.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $20.51 USD hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.