Senior Disability Claims & Case Manager

Sedgwick; Coralville (IA); On-site; USD 65,000 - 85,000; Full time

Job summary

Sedgwick Claims Management Services Ltd is seeking a Disability Representative Sr in Coralville, IA to manage complex disability claims based on medical documentation and plan interpretation.

You will determine benefits due, make timely payments/adjustments, and coordinate return-to-work efforts with providers and employers. A strong background in ERISA, FMLA, and medical terminology is essential.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices.
• Knowledge of state and federal FMLA regulations.
• Excellent oral and written communication, including presentation skills; proficient in MS Office.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial based on plan.
• Reviews complex medical information to determine disability as defined by the plan.
• Negotiates return to work with or without accommodations; coordinates referrals to outside vendors.
• Communicates with claimants and providers to set expectations and inform status.

Skills

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

Analytical

Organization

Negotiation

Teamwork

Decision-making

Autonomy

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves

Tools

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd is seeking a Disability Representative Sr in Coralville, IA to manage complex disability claims based on medical documentation and plan interpretation.

You will determine benefits due, make timely payments/adjustments, and coordinate return-to-work efforts with providers and employers. A strong background in ERISA, FMLA, and medical terminology is essential.