Disability Representative Sr
HybridSouthfield, Michigan, United States or Dubuque, Iowa, United States
Job Summary
Make independent claim determinations for complex disability cases by reviewing medical documentation to approve claims, deny recommendations, or adjust benefits. Medically manage claims involving comorbidities, concurrent plans, and ADA accommodations while coordinating investigative efforts and negotiating return-to-work arrangements. Determine benefits due for workers compensation, SSDI, and other offsets, then communicate status and documentation requirements to claimants and providers. Refer cases to outside vendors or independent medical evaluations as needed and maintain professional client relationships while meeting quality program requirements.
Required Qualifications
- High School diploma or GED
- Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
- Knowledge of state and federal FMLA regulations
- Working knowledge of medical terminology and duration management
- Excellent oral and written communication, including presentation skills
- Proficient computer skills including working knowledge of Microsoft Office
- Analytical, interpretive, and critical thinking skills
- Ability to manage ambiguity
- Strong organizational and multitasking skills
- Ability to work in a team environment
- Ability to meet or exceed performance competencies as required by program
- Effective decision-making and negotiation skills
- Ability to exercise judgement autonomously within established procedures
- 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
- Ability to meet deadlines
- Ability to sit at a desk for extended periods while operating a computer and phone system
- Hearing, vision and talking
- Travel as required
- Must live near one of our centers of excellence: Dubuque, IA or Southfield, MI
Desired Qualifications
- Bachelor's degree from an accredited university or college
- State certification or licensing in statutory leaves
- Preferred or required based on state regulations (State certification or licensing in statutory leaves)
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