LTD Case Specialist

Company Name:
Sedgwick Claims Management Services, Inc.
Job Title: LTD Case Specialist
City: Dubuque
State/Province: Iowa
Position Type: Full Time
LTD Case Specialist
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 a 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,"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 andcollectoverpayments.
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.

Performs other duties as assigned.

Supports the organization's quality program(s).
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required.
Four (4) years of medical disability experience or equivalent combination of education and 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
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 is an Equal Opportunity Employer
and a
Drug-Free Workplace
Additional Information: N/A

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