Disability Claims Specialist — Help People Back to Work

Sedgwick; Los Angeles (CA); On-site; USD 57,308,000 - 80,231,000; Full time

Benefits offered by this job

Medical, dental, vision

401k and matching

PTO

Disability and life insurance

Employee assistance

FS/HSAs offered

Job summary

Sedgwick in Los Angeles is seeking a Disability Representative to assess claims, determine benefits, and coordinate return-to-work plans based on medical documentation and plan interpretation, ensuring timely payments and appropriate adjustments.

You will review medical records, consult clinical resources, communicate clearly with claimants and providers, and collaborate with teams to ensure accuracy, compliance with ERISA and FMLA, and high-quality service standards.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management.
• Knowledge of state and federal FMLA regulations.
• Strong oral and written communication skills and ability to interpret medical information.
• Proficiency with Microsoft Office and claim processing systems.

Responsibilities

• Makes claim determinations and approves routine disability claims or recommends denial as per plan.
• Reviews medical information to determine disability status and benefits due.
• Communicates with claimants and providers to set expectations and provide updates.
• Coordinates investigations and referrals to outside vendors or medical reviews.
• Negotiates return-to-work with or without accommodations and ensures timely payments.
• Maintains quality program compliance and excellent client service.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

MS Office

Analytical thinking

Education

High school diploma or GED

Tools

MS Office

Job description

Sedgwick in Los Angeles is seeking a Disability Representative to assess claims, determine benefits, and coordinate return-to-work plans based on medical documentation and plan interpretation, ensuring timely payments and appropriate adjustments.

You will review medical records, consult clinical resources, communicate clearly with claimants and providers, and collaborate with teams to ensure accuracy, compliance with ERISA and FMLA, and high-quality service standards.