Sedgwick Is Hiring A Disability Representative Sr

Join Sedgwick and be part of a meaningful team dedicated to helping people facing the unexpected. With over 33,000 colleagues worldwide, you'll find opportunities for growth, a caring culture, and a healthy work-life balance. 🚀

Recognition & Certifications

• Newsweek Recognizes Sedgwick as America's Greatest Workplaces
• Certified as a Great Place to Work
• Included in Fortune's Best Workplaces in Financial Services & Insurance

Position: Disability Representative Sr - French Canadian 🇨🇦

Bilingual French Canadian Speaking Required

Primary Purpose

Provides disability case management and makes complex claim determinations based on medical documentation and disability plan interpretation. Responsibilities include determining benefits, making timely payments and adjustments, medically managing claims—including comorbidities, concurrent plans, and ADA accommodations—coordinating investigations, reviewing contested claims, negotiating return-to-work plans, and referring claims to outside vendors.

Essential Functions & Responsibilities

• Claims Decision-Making: Independently approve or recommend denial of complex disability claims based on received information.
• Medical Review: Analyze complex medical information such as physician statements, operative reports, etc., to assess disability status.
• Complex Claim Oversight: Manage facets like comorbidities, ADA accommodations, and claims outside typical guidelines.
• Clinical Resources Utilization: Use clinical resources and guidelines to assess claims durations.
• Benefit Determination & Payments: Calculate benefits due and process timely payments for workers’ compensation, SSDI, and other offsets.
• Claimant Communication: Inform claimants of documentation needs, timelines, and claim status via phone, written correspondence, or system updates.
• Return to Work Coordination: Communicate with providers and claimants to set expectations and facilitate smooth return-to-work transitions.
• Compliance & Management: Ensure claims are medically and administratively compliant, managing complex claims effectively.
• Investigations & Referral: Coordinate investigations and refer claims to vendors or physicians for reviews and evaluations.
• Negotiation & Advocacy: Negotiate return-to-work plans with or without job accommodations involving physicians and employers.
• Documentation & Relationships: Maintain professional relationships and provide excellent customer service while meeting quality standards.
• Team Support: Refer cases for additional review when needed, and support team objectives.

Additional Functions & Responsibilities

Perform other duties as assigned to support team and organizational goals.

Qualifications

Education & Licensing

• High School diploma or GED required.
• Bachelor's degree from an accredited institution preferred.
• State certification or licensing in statutory leaves is preferred or may be required based on regulations.

Experience

• Minimum of 3 years benefits or disability case/claims management experience or equivalent education and experience.

Skills & Knowledge

• Understanding of ERISA regulations, offsets, deductions, and medical management practices.
• Familiarity with FMLA regulations at state and federal levels.
• Proficient in medical terminology and claims duration management.
• Excellent oral & written communication skills, including presentations.
• Strong computer skills, including Microsoft Office.
• Analytical thinking, critical reasoning, and decision-making capabilities.
• Ability to manage ambiguity and multitask effectively.
• Strong organizational skills and team collaboration.
• Autonomous judgment and negotiation skills.

Work Environment & Physical Demands

Mental

Clear thinking, good judgment, problem-solving, and discretion to handle stress and multiple priorities.

Physical

Ability to sit at a desk for extended periods, operate a computer and phone, with occasional travel as needed.

Auditory & Visual

Hearing, vision, and speaking necessary for effective communication.

The statements herein are intended to describe the general nature of the work and are not a comprehensive list. Management retains discretion to modify duties as needed.

🔶 Equal Opportunity Employer & Drug-Free Workplace

If your experience isn't a perfect match but you're excited about this role, we encourage you to apply anyway! Sedgwick values diversity, equity, and inclusion, recognizing unique skills, knowledge, and experiences. You might be the perfect fit for this or other opportunities. 🌟