Disability Claims & Coordination Specialist

Sedgwick Claims Management Services Ltd; Eden Prairie (MN); On-site; USD 28,000 - 40,000; Full time

Job summary

Sedgwick seeks a Disability Claims Specialist to assess routine claims, interpret disability plans, and manage benefits payments. You will coordinate with providers, reviews medical information, and negotiate return-to-work arrangements with or without accommodations.

The role requires knowledge of ERISA, disability management, and strong communication skills, with a focus on timely, accurate determinations and excellent client service.

Qualifications

• High school diploma or GED required.
• State certification or licensing in statutory leaves preferred or may be required based on state regulations.
• Two (2) years of related experience or equivalent combination of education and experience required.
• One (1) year of office or customer service experience required.
• One (1) year of benefits or claims management experience preferred.

Responsibilities

• Makes claim determinations, based on information received, to approve routine disability claims or recommends denial to team lead.
• Reviews and analyzes routine medical information to determine disability as defined by the plan.
• Determines benefits due and makes timely payments and adjustments for workers compensation and SSDI.
• Informs claimants of documentation required and claims status by phone or claims system.
• Communicates with providers to set expectations regarding return to work.
• Medically manages routine disability claims ensuring compliance with duration guidelines.
• Coordinates investigative efforts and reviews contested claims thoroughly.
• Refers cases to outside vendors or physician advisors as needed.

Skills

ERISA knowledge

Disability claims

Communication skills

Negotiation

Return-to-work

Medical terminology

Microsoft Office

Education

High school diploma

Statutory leaves licensing

Tools

Claims systems

Job description

Sedgwick seeks a Disability Claims Specialist to assess routine claims, interpret disability plans, and manage benefits payments. You will coordinate with providers, reviews medical information, and negotiate return-to-work arrangements with or without accommodations.

The role requires knowledge of ERISA, disability management, and strong communication skills, with a focus on timely, accurate determinations and excellent client service.