Senior Disability Representative

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Manages disability cases and makes complex claim decisions based on medical documentation and relevant disability plan interpretation.

• Assesses benefits owed and ensures timely payments, approvals, and adjustments are made.

• Oversees the medical management of disability claims that involve comorbidities, concurrent plans, and intricate ADA accommodations.

• Makes independent decisions to approve intricate disability claims or suggests denial to the team lead.

• Evaluates and interprets complex medical data to ascertain whether claimants meet the disability criteria outlined in the plan.

• Engages clinical resources for case assessment as required.

• Guides claimants on necessary documentation, timelines, payment details, and claim status updates.

• Interacts with claimants, providers, and clients regarding the claims process and expectations for returning to work.

• Coordinates investigative activities and reviews disputed claims.

• Directs claims for vendor services, physician advisor assessments, surveillance, independent medical evaluations, and functional capability evaluations.

• Facilitates return-to-work negotiations with or without accommodations through the claimant’s physician and employer.

• Refers cases to the team lead and clinical case management for further evaluation.

• Maintains professional relationships with clients and delivers exceptional customer service.

• Meets the requirements of the organizational quality program.

• Performs additional duties as assigned.

⛳️ Requirements

• High School diploma or GED is mandatory.

• A Bachelor's degree from an accredited university or college is preferred.

• State certification or licensing in statutory leaves is preferred or may be necessary based on state laws.

• A minimum of three (3) years of experience in benefits or disability case/claims management, or an equivalent combination of education and experience is preferred.

• Familiarity with ERISA regulations, necessary offsets and deductions, disability duration, medical management practices, and Social Security application processes.

• Understanding of state and federal FMLA regulations.

• Proficient in medical terminology and duration management.

• Exceptional oral and written communication skills, including presentation abilities.

• Strong computer skills with proficiency in Microsoft Office.

• Strong analytical, interpretive, and critical thinking capabilities.

• Ability to navigate ambiguity effectively.

• Excellent organizational and multitasking skills.

• Capability to collaborate within a team setting.

• Ability to meet or surpass performance competencies as required by the program.

• Effective decision-making and negotiation abilities.

• Ability to exercise independent judgment according to established procedures.

• Capability to remain seated at a desk for extended periods while using a computer and phone system.

• Willingness to travel as needed.

🏝️ Benefits

• Work-life balance.

• Reasonable accommodations when applicable and suitable.

• A diverse, equitable, and inclusive work environment.

• Equal Opportunity Employer.

• Drug-free workplace.