Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Chicago (IL); Hybrid; USD 32,000 - 34,000; Full time

Benefits offered by this job

Medical, dental, vision

401k and matching

PTO

Disability and life insurance

Employee assistance

Flexible spending / HSA

Job summary

Sedgwick is seeking a Disability Representative Sr to perform complex disability case management in Chicago, IL. The role involves reviewing medical documentation, determining benefits, and coordinating return-to-work with providers and employers.

You will handle challenging claims, ensure timely payments, and maintain professional client relationships, while adhering to plan provisions and regulatory guidelines.

Qualifications

• High School diploma or GED required; Bachelor's degree preferred.
• Experience in benefits or disability case/claims management is desirable.
• Strong knowledge of ERISA, FMLA, and disability duration management is required.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or advise denial when appropriate.
• Reviews complex medical documents to determine disability status per plan definitions.
• Coordinates investigations, ADA accommodations, and referrals to outside vendors or physicians.
• Communicates with claimants and providers to set expectations and update on claims status.
• Negotiates return-to-work with or without accommodations with treating providers and employers.

Skills

ERISA knowledge

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Negotiation skills

Teamwork

Education

High School diploma or GED

Bachelor's degree preferred

Tools

Claims system

MS Excel

Microsoft Word

Job description

Sedgwick is seeking a Disability Representative Sr to perform complex disability case management in Chicago, IL. The role involves reviewing medical documentation, determining benefits, and coordinating return-to-work with providers and employers.

You will handle challenging claims, ensure timely payments, and maintain professional client relationships, while adhering to plan provisions and regulatory guidelines.