Claims Representative jobs in Aurora, IL
Recently Added Claims Representative jobs
Sr. Disability Representative
- Sedgwick Claims Management Services Inc.
-
Chicago, IL
OTHER
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace® Forbes Best-in-State Employer Sr. Disability Representative PRIMARY PURPOSE: To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan. Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan. Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians). Communicates with the claimants providers to set expectations regarding return to work. Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. Negotiates return to work with or without job accommodations via the claimants physician and employer. Refers cases as appropriate to team lead and clinical case management. Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited university or college preferred. Experience Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required. Skills & Knowledge Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures Working knowledge of medical terminology and duration management Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Ability to work in a team environment Excellent negotiation skills 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 is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Taking care of people is at the heart of everything we do. Caring counts Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us.
- 6 Days Ago
Workforce Absence Care Team Representative
- Sedgwick Claims Management Services Inc.
-
Chicago, IL
OTHER
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
- Just Posted
Auto PD Claims Adjuster
- TheBest Claims Solutions
-
Bedford, IL
OTHER
- Our client is seeking a Auto PD Claims Adjuster to work out of their Bedford Park, IL office. Ideal Candidates will have 2 years of experience handling Auto Insurance claims for a Non-Standard Auto In...
- 1 Day Ago
Warranty Claims Representative
- IKO Midwest Inc.
-
Kankakee, IL
FULL_TIME
- IKO Industries Ltd. is a market leader in the manufacturing of roofing and building materials. IKO is a Canadian owned and operated business with production facilities worldwide and has many years of ...
- 2 Days Ago
Senior Claims Representative
- Liberty Mutual Insurance
-
Hoffman, IL
FULL_TIME
- Pay PhilosophyThe typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this ...
- 2 Days Ago
Warranty Claims Representative
- IKO North America
-
Kankakee, IL
FULL_TIME
- IKO Industries Ltd. is a market leader in the manufacturing of roofing and building materials. IKO is a Canadian owned and operated business with production facilities worldwide and has many years of ...
- 2 Days Ago
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0 Claims Representative jobs found in Aurora, IL area
Claims- Field Claims Representative
- Cincinnati Insurance Company, Inc.
-
Schaumburg, IL
- Description: Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and...
- 6/7/2024 12:00:00 AM
Pricing Actuary
- Vallum Associates
-
Chicago, IL
- Senior Pricing Actuarial Analyst - Pricing - Chicago - Hybrid - Up to $160,000 I am currently working with a World Leadi...
- 6/7/2024 12:00:00 AM
Worker's Compensation Attorney
- Del Galdo Law Group, LLC
-
Berwyn, IL
- Del Galdo Law Group, LLC specializes in representing public entities with offices in Berwyn and Chicago. We also offer r...
- 6/5/2024 12:00:00 AM
WC Claim Advocate I LevelUP (Advocate Training Program, In Office)
- CCMSI
-
Lisle, IL
- Overview: Join Our Team at CCMSI - Illinois Public Risk Fund CCMSI is seeking talented individuals to join the Illinois ...
- 6/5/2024 12:00:00 AM
Account Executive
- Kelly Science, Engineering, Technology & Telecom
-
Chicago, IL
- Are you competitive, money motivated, a relationship builder? We are looking for a Scientific Account Executive to ident...
- 6/5/2024 12:00:00 AM
Employee Relations Specialist - Bilingual
- Fresh Express
-
Streamwood, IL
- The Human Resource Employee Relations Specialist is directly responsible for supporting the Employee Relations and FSSC ...
- 6/4/2024 12:00:00 AM
Assistant Teacher
- The Learning Experience - Corporate Childcare Centers
-
Naperville, IL
- Benefits: Dental insurance Health insurance Vision insurance Assistant Teachers at The Learning Experience are not just ...
- 6/4/2024 12:00:00 AM
General Liability Attorney
- Hennessy & Roach, P.C.
-
Chicago, IL
- Successful Midwestern law firm seeks a General Liability and Civil Litigation Attorney with three or more years of exper...
- 6/3/2024 12:00:00 AM
About Aurora, Illinois
Aurora, a suburb of Chicago, is a city in DuPage, Kane, Kendall, and Will counties in the U.S. state of Illinois. Located primarily in DuPage and Kane counties, it is an outer suburb of Chicago and the second most populous city in the state, and the 114th most populous city in the country. The population was 197,899 at the 2010 census, and was estimated to have increased to 200,965 by 2017.
Once a mid-sized manufacturing city, Aurora has grown since the 1960s. Founded within Kane County, Aurora's city limits and population have expanded into DuPage, Will, and Kendall counties. Between 2000 an...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Representative jobs
$49,456 to $63,070
Aurora, Illinois area prices
were up 0.8% from a year ago
were up 0.8% from a year ago
What does a Claims Representative do?
Claims Representative
Handle calls from the Nationwide Toll-Free Service which may originate from any area within the network or from another network-this comprises of about 65% of the position.
November 17, 2022
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic.
December 21, 2022
Provides direct guidance and assistance to customers regarding processing procedures and explains how their inquiries will be answered if additional information is requested.
January 01, 2023
Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policy and procedures.
February 28, 2023
Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing .
April 06, 2023
Performs timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements.
April 08, 2023
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
April 10, 2023
Assist in the department's effort to continuously improve service by identifying and recommending changes or additions to current workflow, practices, processes, procedures, systems, and training.
May 10, 2023
Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
May 10, 2023
Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies.
May 15, 2023