Senior Disability Case Manager - Impactful Claims & Recovery

Sedgwick; Dubuque (IA); On-site; USD 95,000 - 115,000; Full time

Job summary

Sedgwick in Dubuque, IA seeks a Sr Disability Representative to manage complex disability claims, interpret medical documentation, and determine benefits under applicable plans. You will assess eligibility, coordinate benefits, and ensure compliance with ERISA regulations.

In this role you will coordinate return-to-work strategies, collaborate with physicians, and ensure timely payments while maintaining excellent client service.

Qualifications

• High School diploma or GED required; Bachelor's degree from an accredited university or college preferred.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial based on the plan.
• Reviews complex medical information to determine disability status as defined by the plan.
• Oversees comorbidities, concurrent plans, ADA accommodations, and non-standard claims.
• Determines benefits due and ensures timely payments/adjustments for disability claims.
• Negotiates return to work with or without accommodations with providers and employers.

Skills

ERISA regulations knowledge

FMLA regulations knowledge

Medical terminology knowledge

Communication skills

Microsoft Office

Analytical thinking

Negotiation skills

Team player

Education

Bachelor's degree preferred

High School diploma or GED required

Statutory leaves licensing/certification preferred

Tools

None

Job description

Sedgwick in Dubuque, IA seeks a Sr Disability Representative to manage complex disability claims, interpret medical documentation, and determine benefits under applicable plans. You will assess eligibility, coordinate benefits, and ensure compliance with ERISA regulations.

In this role you will coordinate return-to-work strategies, collaborate with physicians, and ensure timely payments while maintaining excellent client service.