Senior Disability Claims Navigator

Sedgwick Claims Management Services Ltd; Southfield (MI); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Sedgwick Claims Management Services Ltd is seeking a Sr. Disability Representative to manage complex disability claims, determine benefits due, and coordinate return-to-work with accommodations.

The role requires evaluating medical documentation, applying disability plan interpretations, and liaising with claimants and providers across the claims system. The ideal candidate has strong knowledge of ERISA, FMLA, and medical terminology, plus excellent communication and negotiation skills to ensure

Qualifications

• High School diploma or GED required.
• Bachelor's degree preferred.
• State certification or licensing in statutory leaves 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.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures.
• Knowledge of state and federal FMLA regulations.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• Proficient computer skills including working knowledge of Microsoft Office.
• Analytical, interpretive, and critical thinking skills.
• Ability to manage ambiguity.
• Strong organizational and multitasking skills.
• Ability to work in a team environment.
• Ability to meet or exceed performance competencies as required by program.
• Effective decision-making and negotiation skills.
• Ability to exercise judgement autonomously within established procedures.

Responsibilities

• Makes independent claim determinations and approves complex disability claims.
• Reviews complex medical information to determine disability status.
• Oversees facets of complex claims including comorbidities and ADA accommodations.
• Utilizes clinical resources as needed.
• Determines benefits due and processes timely payments/adjustments.
• Informs claimants of documentation required and timelines.
• Communicates with providers to set return-to-work expectations.
• Medically manages disability claims in line with guidelines.
• Communicates with claimants and clients about the claims process.
• Coordinates referrals to outside vendors or physician reviews.
• Negotiates return to work with/without job accommodations.
• Maintains client relationships and high-quality service.
• Meets quality program requirements.

Skills

Disability case management

Claims analysis

Communication

Negotiation

Microsoft Office

ERISA knowledge

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd is seeking a Sr. Disability Representative to manage complex disability claims, determine benefits due, and coordinate return-to-work with accommodations.

The role requires evaluating medical documentation, applying disability plan interpretations, and liaising with claimants and providers across the claims system. The ideal candidate has strong knowledge of ERISA, FMLA, and medical terminology, plus excellent communication and negotiation skills to ensure