Hybrid Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Orlando (FL); Hybrid; USD 30,000 - 34,000; Full time

Job summary

Sedgwick is hiring a Disability Representative Sr to perform disability case management and complex claim determinations based on medical documentation and plan interpretation. The role involves coordinating with providers, assessing eligibility, and ensuring timely payments and adjustments.

The position supports on-site collaboration with a hybrid work arrangement in Orlando, FL, and requires strong analytical, negotiation, and communication skills.

Qualifications

• High School diploma or GED required.
• Bachelor's degree from an accredited university or college preferred.
• State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or recommends denial.
• Reviews and analyzes complex medical information to determine disability per plan.
• Oversees complex claims including comorbidities and ADA accommodations.
• Determines benefits due per plan and processes timely payments/adjustments.
• Communicates with claimants and providers to set expectations on return to work.

Skills

Disability management

Claims analysis

Communication skills

ERISA knowledge

Microsoft Office

Negotiation

Attention to detail

Teamwork

Education

High School diploma

Bachelor's degree preferred

Tools

Claims system

Job description

Sedgwick is hiring a Disability Representative Sr to perform disability case management and complex claim determinations based on medical documentation and plan interpretation. The role involves coordinating with providers, assessing eligibility, and ensuring timely payments and adjustments.

The position supports on-site collaboration with a hybrid work arrangement in Orlando, FL, and requires strong analytical, negotiation, and communication skills.