Senior Disability Claims & Return-to-Work Specialist

Sedgwick Claims Management Services Ltd; Southfield (MI); On-site; USD 70,000 - 100,000; Full time

Job summary

Sedgwick Claims Management Services Ltd is seeking a Sr. Disability Representative to manage complex disability claims, review medical documentation, and interpret disability plans. The role involves coordinating return-to-work strategies, ensuring timely payments, and liaising with claimants and providers.

The ideal candidate will have strong knowledge of ERISA, FMLA, medical terminology, and excellent communication, with a track record in complex claim management.

Qualifications

• High School diploma or GED required; Bachelor’s degree preferred.
• State certification/licensing in statutory leaves preferred or may be required by state regulations.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial to team lead.
• Reviews complex medical information to determine disability status per plan.
• Oversees comorbidities, concurrent plans, ADA accommodations and claims outside guidelines.
• Determines benefits due; processes payments/adjustments for workers’ comp, SSDI, offsets.
• Communicates with claimants and providers about processing steps, timeframes, and status.
• Coordinates investigations and review of contested claims; refers to outside vendors/advisors as needed.
• Negotiates return-to-work or accommodations with employers; escalates when needed.
• Maintains professional relationships and adheres to quality programs.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communications

Analytical thinking

Negotiation

Decision making

Teamwork

Organization

Ambiguity management

Presentation skills

Education

High School diploma or GED

Bachelor’s degree preferred

Statutory leaves licensing/licensing

Tools

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd is seeking a Sr. Disability Representative to manage complex disability claims, review medical documentation, and interpret disability plans. The role involves coordinating return-to-work strategies, ensuring timely payments, and liaising with claimants and providers.

The ideal candidate will have strong knowledge of ERISA, FMLA, medical terminology, and excellent communication, with a track record in complex claim management.