Senior Disability Claims Specialist

NADR; California; Presencial; USD 36.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

401k matching

Paid time off

Disability insurance

Life insurance

Employee assistance

HSA/FSA

Descripción de la vacante

Sedgwick is seeking a Sr. Disability Representative to perform disability case management and complex claim determinations based on medical documentation and plan interpretation.

You will determine benefits, coordinate investigations, and negotiate return-to-work with or without accommodations. The role requires 3+ years of disability claims experience and knowledge of ERISA and FMLA, plus strong communication skills.

Formación

• Knowledge of ERISA regulations, required offsets and deductions.
• Understanding of FMLA regulations and disability duration management.
• Excellent oral and written communication skills.
• Proficient with Microsoft Office and case management systems.
• Ability to analyze medical information and make determinations.

Responsabilidades

• Makes independent claim determinations to approve complex disability claims.
• Reviews complex medical information to determine disability status.
• Negotiates return to work with or without accommodations with stakeholders.
• Coordinates referrals to outside vendors and physician reviews as needed.
• Maintains professional client relationships and ensures high service levels.

Conocimientos

ERISA regulations

FMLA regulations

Medical terminology

Communication

Microsoft Office

Analytical thinking

Decision making

Negotiation

Autonomy

Teamwork

Educación

Bachelor's degree (preferred)

Herramientas

Microsoft Office

Descripción del empleo

Sedgwick is seeking a Sr. Disability Representative to perform disability case management and complex claim determinations based on medical documentation and plan interpretation.

You will determine benefits, coordinate investigations, and negotiate return-to-work with or without accommodations. The role requires 3+ years of disability claims experience and knowledge of ERISA and FMLA, plus strong communication skills.