Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Cedar Rapids (IA); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Sedgwick Claims Management Services Ltd. seeks a Sr Disability Representative to oversee disability case management and make complex claim determinations based on medical documentation and plan interpretation.

You will coordinate investigations, facilitate return-to-work negotiations, and ensure timely payments while maintaining strong client communication and adherence to ERISA and FMLA guidelines. Travel may be required.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices.
• 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 and multitask in a team environment.
• Strong organizational and negotiation skills.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial based on plan.
• Reviews complex medical information to determine disability as defined by the plan.
• Oversees comorbidities, concurrent plans and ADA accommodations in complex claims.
• Determines benefits due and processes timely payments/adjustments.
• Communicates with claimants, providers, and clients about status and requirements.
• Negotiates return to work with or without accommodations with physicians and employers.
• References outside vendors or physician reviews when appropriate.

Skills

ERISA regulations knowledge

FMLA regulations knowledge

Medical terminology

Oral and written communication

Microsoft Office

Analytical thinking

Decision making

Negotiation skills

Education

High School diploma or GED

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

Sedgwick Claims Management Services Ltd. seeks a Sr Disability Representative to oversee disability case management and make complex claim determinations based on medical documentation and plan interpretation.

You will coordinate investigations, facilitate return-to-work negotiations, and ensure timely payments while maintaining strong client communication and adherence to ERISA and FMLA guidelines. Travel may be required.