Disability Claims Specialist — Complex Case Management

Sedgwick; Cedar Rapids (IA); On-site; USD 60,000 - 80,000; Full time

Job summary

Sedgwick in Cedar Rapids, IA is seeking an experienced Disability Representative Sr. to join our team and manage complex disability claims. You will review medical documentation, determine benefits, and coordinate return-to-work plans with employers and providers.

Ideal candidates have 3+ years in benefits or disability claims, knowledge of ERISA and FMLA, and strong communication and analytical skills. We offer a collaborative environment and opportunities for growth.

Qualifications

• 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
• Knowledge of state and federal FMLA regulations
• 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
• Effective decision-making and negotiation skills

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, ADA accommodations, and claims outside typical guidelines.
• Utilizes clinical resources in case assessment as needed.
• Determines benefits due pursuant to a disability plan, and makes timely payments/adjustments for workers compensation, SSDI, and other offsets.
• Informs claimants of required documentation, time frames, payment information and claims status.
• Communicates with claimant providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
• Coordinates with claimants and clients on all aspects of claims process by phone or written correspondence.
• Evaluates and arranges referrals to outside vendors or physician reviews as appropriate.
• Negotiates return to work with or without accommodations via physician and employer.

Skills

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

MS Office

Analytical thinking

Problem solving

Organizational skills

Teamwork

Decision making

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Sedgwick in Cedar Rapids, IA is seeking an experienced Disability Representative Sr. to join our team and manage complex disability claims. You will review medical documentation, determine benefits, and coordinate return-to-work plans with employers and providers.

Ideal candidates have 3+ years in benefits or disability claims, knowledge of ERISA and FMLA, and strong communication and analytical skills. We offer a collaborative environment and opportunities for growth.