Disability Representative

Sedgwick; Indianapolis (IN); Hybrid; USD 28,929 - 30,307; Full time

Benefits offered by this job

Comprehensive benefits package

Career development opportunities

Flexible spending or health savings accounts

Job summary

Sedgwick is looking for a Disability Representative based in Indianapolis, Indiana. This role focuses on providing disability case management and ensuring accurate claim determinations based on medical documentation.

The successful candidate will manage disability claims, communicate with claimants and providers, and ensure compliance with relevant regulations. A two-year background in claims management and a high school diploma are required.

Flexible working options and a comprehensive benefits package are offered.

Qualifications

• High school diploma or GED required.
• State certification or licensing in statutory leaves preferred.
• Two years of related experience or equivalent combination of education and experience.

Responsibilities

• Provide disability case management and routine claim determinations.
• Make timely claims payments and approvals.
• Communicate with claimants regarding claim status.

Skills

Knowledge of ERISA regulations

Excellent oral and written communication

Analytical and critical thinking skills

Proficient in Microsoft Office

Strong organizational and multitasking skills

Effective decision-making skills

Education

High school diploma or GED

Job description

Disability Representative

By joining Sedgwick, you will be part of a team that supports employees and customers from some of the world’s most respected brands. This role focuses on providing disability case management and routine claim determinations based on medical documentation and applicable disability plan interpretation.

What we offer

• A stable, consistent work environment – both in‑office and virtual.
• $21.82 per hour.
• A comprehensive training program to assist in supporting employees and customers.
• A dedicated mentor and manager to guide your career development.
• Career development and promotional opportunities as you take on new responsibilities.
• A diverse, all‑inclusive benefits package designed to support your well‑being.

Primary Purpose

Provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation. Responsibilities include determining benefits due, making timely payments and approvals, managing disability claims medically, coordinating investigative efforts, reviewing contested claims, negotiating return to work, and arranging referrals to vendors.

Essential Functions and Responsibilities

• Make claim determinations to approve routine disability claims or recommend denial based on the plan.
• Review and analyze routine medical information to determine claimant disability status.
• Utilize clinical resources for case assessment.
• Determine benefits due and make timely claims payments and adjustments.
• Inform claimants of required documentation, time frames, payment information, and claim status by phone, written correspondence, or claims system.
• Communicate with claimants’ providers to set expectations regarding return to work.
• Medically manage routine disability claims ensuring compliance with guidelines and plan provisions.
• Communicate clearly and timely with claimant and client on all aspects of the claims process.
• Coordinate investigative efforts and provide a thorough review of contested claims.
• Arrange referrals to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and related disability activities.
• Negotiate return to work with or without job accommodations via the provider and employer.
• Refer cases to team lead and clinical case management for assistance with claim determination.
• Meet the organization’s quality program minimum requirements.
• Maintain professional client relationships and provide excellent customer service.

Additional Functions and Responsibilities

• Perform other duties as assigned.

Qualifications

Education & Licensing

High school diploma or GED required. State certification or licensing in statutory leaves is preferred or may be required based on state regulations.

Experience

Two years of related experience or an equivalent combination of education and experience required. One year of office or customer service experience required. One year of benefits or claims management experience preferred.

Skills & Knowledge

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures.
• Knowledge of state and federal FMLA regulations.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• Proficient computer skills, including knowledge of Microsoft Office.
• Analytical, interpretive, and critical thinking skills.
• Strong organizational and multitasking skills.
• Ability to work in a team environment.
• Ability to meet or exceed performance competencies required by the program.
• Effective decision‑making and negotiation skills.
• Ability to exercise judgment with limited supervision.

Work Environment

Mental

Clear and conceptual thinking, excellent judgment and discretion, ability to handle work‑related stress and multiple priorities, and ability to meet deadlines.

Physical

Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.

Auditory/Visual

Hearing, vision, and speaking.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency. The starting pay for this role is $21.82. A comprehensive benefits package is offered including medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.