PRIMARY PURPOSE: To process claims and determine benefits due pursuant to a disability plan; to make timely payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets; and to ensure the ongoing processing of claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.

• Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

• 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.

• 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. College preferred.

Experience

Two (2) years of related experience or equivalent combination of education and experience required to include one (1) year general office or customer service experience. One (1) year of benefits or claims management experience preferred.

Skills & Knowledge

• Excellent oral and written communication

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational 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 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 a specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 21.82. 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.