Senior Disability Claims & Case Manager

Sedgwick Claims Management Services Ltd; South Portland (ME); Híbrido; USD 29.000 - 40.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision benefits

401(k) with matching

Paid time off (PTO)

Descripción de la vacante

Sedgwick is seeking a Disability Representative Sr to join our team in a hybrid work model. You will assess complex disability claims, review medical documentation, determine eligibility, and coordinate return-to-work arrangements with claimants, providers, and clients.

Ideal candidates bring 3+ years of disability claims experience, a high school diploma (bachelor’s preferred), and strong knowledge of ERISA and FMLA.

Formación

• Three (3) years of benefits or disability case/claims management experience or equivalent.
• 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 computer skills including Microsoft Office
• Analytical, interpretive, and critical thinking skills

Responsabilidades

• Makes independent claim determinations and approves complex disability claims or recommends denial based on the plan.
• Reviews complex medical information to determine disability status per plan.
• Oversees complex claims including comorbidities, accommodations, and external referrals
• Coordinates return-to-work discussions with providers and employers
• Communicates with claimants and clients on statuses and required documentation
• Maintains professional client relationships and supports quality programs

Conocimientos

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Analytical thinking

Decision-making

Negotiation

Teamwork

Educación

High School diploma or GED

Bachelor’s degree preferred

State certification/licensing for statutory leaves

Herramientas

Microsoft Office

Descripción del empleo

Sedgwick is seeking a Disability Representative Sr to join our team in a hybrid work model. You will assess complex disability claims, review medical documentation, determine eligibility, and coordinate return-to-work arrangements with claimants, providers, and clients.

Ideal candidates bring 3+ years of disability claims experience, a high school diploma (bachelor’s preferred), and strong knowledge of ERISA and FMLA.