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Job Field: Legal Jobs
Location: Pasadena, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Job Title: Disability SpecialistCity: PasadenaState/Province: CaliforniaPosition Type: Full TimeDescription: Disability SpecialistCLAIM YOUR FUTURE AS A GREAT PERFORMER!Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as theBest TPA in Americaand the covetedEmployer of Choicedesignation, we invite you to come be a part of our team and,&ldquo;Claim Your Future.&rdquo;PRIMARY PURPOSE: To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level.ESSENTIAL FUNCTIONS and RESPONSIBILITIES* Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.* Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.* Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.* Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.* 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.* Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.* Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.* Refers cases as appropriate to supervisor and management.* Negotiates settlement of claims up to designated authority level.* Maintains professional client relationships.ADDITIONAL FUNCTIONS and RESPONSIBILITIES* Performs other duties as assigned.* Supports the organization&#39;s quality program(s).QUALIFICATIONSEducation & LicensingBaccalaureate degree from an accredited college or university in nursing, social work or vocational rehabilitation is preferred. At least one of the following licenses is required: RN, LVN, CRC, COHN, CVE, LPC or LCSW.ExperienceThree (3) years benefits or disability claims management experience required.Skills & Knowledge* Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures* Excellent oral and written communication, including presentation skills* PC literate, including Microsoft Office products* Analytical and interpretive skills* Strong organizational skills* Ability to work in a team environment* Excellent negotiation skills* Ability to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptualthinking 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 deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingNOTE: 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 an

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