Senior Disability Claims Specialist

Sedgwick; Chicago (IL); On-site; USD 32,000 - 34,000; Full time

Job summary

Sedgwick is seeking a Senior Disability Representative to manage complex disability claims, review medical documentation, and coordinate benefits determinations. You will ensure timely payments, negotiate return-to-work, and maintain adherence to plan provisions.

Ideal candidates have 3+ years in benefits or disability claims management, strong communication, and teamwork. Sedgwick offers comprehensive benefits and a caring culture.

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

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial to team lead.
• Reviews complex medical information to determine if the claimant is disabled as defined by the plan.
• Oversees comorbidities, concurrent plans, ADA accommodations and outside vendor referrals.
• Uses clinical resources in case assessment as needed.
• Determines benefits due and makes timely payments/adjustments.
• Informs claimants of required documentation and timelines.
• Communicates with providers to set expectations for return to work.
• Medically manages disability claims ensuring duration control and plan provisions.
• Communicates with claimant and client on the claims process.
• Coordinates investigations and reviews of contested claims.
• Evaluates referrals to outside vendors or physician reviews as needed.
• Negotiates return to work with or without accommodations.
• Maintains professional client relationships and meeting quality standards.

Skills

Disability management

Medical knowledge

Communications

Negotiation

Teamwork

Analytical thinking

Education

High School diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is seeking a Senior Disability Representative to manage complex disability claims, review medical documentation, and coordinate benefits determinations. You will ensure timely payments, negotiate return-to-work, and maintain adherence to plan provisions.

Ideal candidates have 3+ years in benefits or disability claims management, strong communication, and teamwork. Sedgwick offers comprehensive benefits and a caring culture.