Ltd Case Specialist

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.
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LTD Case Specialist
PRIMARY PURPOSE: To analyze claims and determine benefits due ensuring compliance with plan provisions; to determine need for outside vendors, surveillance, and/or independent medical evaluations; to negotiate settlements and to make claim payments and revisions within designated authority level; and to calculate and collect overpayments.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes assigned claims and determines benefits due.
• Informs claimants of documentation required to process their claim and timeframes.
• Manages claim to ensure compliance with plan provisions.
• Provides appropriate documentation to LTD Manager for reporting purposes.
• Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.
• Refers cases to LTD Supervisor, LTD Manager, or Project Manager.
• Negotiates settlement of appropriate claims within designated authority level.
• Makes claim payments and revisions to benefit amounts.
• Communicates status on decisions to client, claimant and supervisor.
• Calculates and collects overpayments.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required.
Experience
Four (4) years of medical disability experience or equivalent combination of education and experience required.
Skills & Knowledge

• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent 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.
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.