**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.**
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®
Most Loved Workplace®
Forbes Best-in-State Employer
**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).
**Education & Licensing**
High school diploma or GED required.
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
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.
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.**
- Claim Processing
- Clinical Works
- Customer Relationship Management