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LTD Case Manager II
at Sedgwick CMS in California
Long Term Disability Case Manager II
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
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.
Maintains a quality assurance program to support the total performance management initiative and the consistent delivery of quality claims service.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required
Experience
Two (2) years of medical disability 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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar: http://sedgwickcms.contacthr.com/16695790
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
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.
Maintains a quality assurance program to support the total performance management initiative and the consistent delivery of quality claims service.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required
Experience
Two (2) years of medical disability 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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar: http://sedgwickcms.contacthr.com/16695790
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Published on Jul 31, 2010
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