Disability Claims Specialist — Impactful Case Management

Sedgwick Claims Management Services Ltd; Irving (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

Sedgwick Claims Management Services Ltd is seeking a Disability Representative to evaluate disability claims, determine benefits, and manage routine payments. The role involves reviewing medical information, coordinating with providers, and ensuring timely decisions under disability plans.

The candidate will need to apply ERISA and FMLA knowledge, communicate clearly with claimants, and coordinate recoveries and referrals as part of end-to-end claims handling.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, and disability duration and medical management practices.
• Familiarity with state and federal FMLA regulations and procedures.
• Proficiency in medical terminology and duration management; data entry and documentation accuracy.

Responsibilities

• Makes claim determinations to approve routine disability claims or recommends denial as needed.
• Reviews medical information or consults with a nurse to determine disability per plan.
• Communicates with claimants and providers about documentation, timelines, and status.
• Negotiates return to work with or without accommodations; coordinates referrals as needed.

Skills

ERISA rules

FMLA rules

Medical terminology

Education

High school diploma or GED

State certification/licensing in statutory leaves

Tools

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd is seeking a Disability Representative to evaluate disability claims, determine benefits, and manage routine payments. The role involves reviewing medical information, coordinating with providers, and ensuring timely decisions under disability plans.

The candidate will need to apply ERISA and FMLA knowledge, communicate clearly with claimants, and coordinate recoveries and referrals as part of end-to-end claims handling.