Hybrid Disability Claims Specialist

NADR; Irving (TX); Hybrid; USD 27,000 - 30,000; Full time

Benefits offered by this job

Stable environment

Comprehensive training

Mentor and manager

Career development

All-inclusive benefits package

Job summary

Sedgwick is hiring a Disability Representative in Irving, TX to provide disability case management and routine claim determinations based on medical documentation and plan interpretation. You will determine benefits due, coordinate return-to-work efforts, and ensure timely payments and adjustments while collaborating with nurses and physicians.

The role requires 2 years of related experience, strong communication skills, and familiarity with ERISA and FMLA regulations.

Qualifications

• High school diploma or GED required; licensing in statutory leaves preferred or may be required by state.
• Two years of related experience and one year in office or customer service; benefits/claims management preferred.

Responsibilities

• Makes claim determinations to approve routine disability claims or deny based on plan.
• Review medical information and consult with nurse to determine disability status.
• Determine benefits due, make timely payments and adjustments for various disability programs.
• Inform claimants of required documentation and communicate status via phone or claims system.
• Coordinate return-to-work negotiations with physicians and employers.
• Medically manage routine claims and ensure compliance with guidelines.
• Coordinate investigations and referrals to outside vendors or physician reviews.
• Maintain client relationships and provide excellent customer service.

Skills

ERISA regulations knowledge

FMLA regulations knowledge

Medical terminology familiarity

Communication skills

Computer skills

Analytical thinking

Organizational skills

Teamwork

Decision making

Negotiation skills

Education

High school diploma or GED

Statutory leaves licensing preferred

Tools

Microsoft Office

Job description

Sedgwick is hiring a Disability Representative in Irving, TX to provide disability case management and routine claim determinations based on medical documentation and plan interpretation. You will determine benefits due, coordinate return-to-work efforts, and ensure timely payments and adjustments while collaborating with nurses and physicians.

The role requires 2 years of related experience, strong communication skills, and familiarity with ERISA and FMLA regulations.