Disability Representative Sr
$41,059–$49,920 year
On-siteChicago, Illinois, United States or Cedar Rapids, Iowa, United States
Job Summary
Conduct independent claim determinations for complex disability cases by reviewing medical documentation, analyzing comorbidities, and applying ADA accommodations to approve or recommend denials. Medically manage claims ensuring compliance with duration guidelines while coordinating investigative efforts, arranging independent medical evaluations, and negotiating return-to-work plans with employers and physicians. Determine benefits due across workers compensation, SSDI, and other offsets, then communicate status, required documentation, and payment details to claimants via phone and correspondence. Maintain professional client relationships and refer contested cases to team leads or clinical resources as needed.
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
- Travel as required
Desired Qualifications
- Bachelor's degree from an accredited university or college
- State certification or licensing in statutory leaves
- Preferred or may be required based on state regulations
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