Senior Disability Claims & Return-to-Work Specialist

Sedgwick; Orlando (FL); On-site; USD 75,000 - 105,000; Full time

Job summary

Sedgwick in Orlando, FL is seeking a Senior Disability Representative to manage complex disability claims from intake through benefits determinations, using medical documentation and disability plan interpretation to determine appropriate payments and approvals.

You will review medical records, coordinate with clinicians and vendors, negotiate return-to-work arrangements, and maintain strong client communications while meeting plan guidelines and quality standards.

Qualifications

• Bachelor's degree preferred; HS diploma required.
• 3+ years in benefits or disability claims management or equivalent experience.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management.
• Knowledge of state and federal FMLA regulations.
• Excellent oral and written communication, including presentation skills.
• Proficient with Microsoft Office and basic computer skills.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denials.
• Reviews complex medical information to determine disability status per plan definitions.
• Oversees comorbidities, concurrent plans, ADA accommodations, and related aspects of complex claims.
• Coordinates investigative efforts and reviews contested claims thoroughly.
• Negotiates return to work with or without accommodations via treating physicians and employers.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Negotiation skills

Decision making

Teamwork

Problem solving

Education

High School diploma or GED

Bachelor's degree preferred

State certification or licensing in statutory leaves preferred

Job description

Sedgwick in Orlando, FL is seeking a Senior Disability Representative to manage complex disability claims from intake through benefits determinations, using medical documentation and disability plan interpretation to determine appropriate payments and approvals.

You will review medical records, coordinate with clinicians and vendors, negotiate return-to-work arrangements, and maintain strong client communications while meeting plan guidelines and quality standards.