Senior Disability Claims Lead — Hybrid Work

Sedgwick; Chicago (IL); Hybrid; USD 32,000 - 33,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k with match

Paid Time Off

Job summary

Sedgwick is seeking a Sr Disability Representative to manage complex disability claims, based on medical documentation and plan interpretation, including determining benefits and timely payments. You will coordinate with providers, negotiate return to work, and refer cases to outside vendors as needed.

Remote work is hybrid with onsite centers; candidates should live near one of our centers of excellence. Strong clinical and communication skills are essential to ensure accurate, timely results

Qualifications

• 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
• Excellent oral and written communication, including presentation skills

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or recommends denial based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Oversees complex claims including comorbidities, concurrent plans, and ADA accommodations.
• Determines benefits due pursuant to a disability plan, makes timely payments/approvals and adjustments
• Communicates with claimants and providers to set expectations regarding return to work
• Negotiate return to work with or without job accommodations
• Maintains professional client relationships and meets quality program requirements

Skills

Communication

Analytical thinking

Teamwork

Multitasking

Problem solving

Decision making

Negotiation

Organizational skills

Adaptability

Microsoft Office

Education

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Sedgwick is seeking a Sr Disability Representative to manage complex disability claims, based on medical documentation and plan interpretation, including determining benefits and timely payments. You will coordinate with providers, negotiate return to work, and refer cases to outside vendors as needed.

Remote work is hybrid with onsite centers; candidates should live near one of our centers of excellence. Strong clinical and communication skills are essential to ensure accurate, timely results