Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Chicago (IL); On-site; USD 65,904,000 - 71,635,000; Full time

Benefits offered by this job

Medical benefits

401k with matching

PTO

Disability and life insurance

Job summary

Sedgwick Claims Management Services Ltd is seeking a Sr Disability Representative to manage complex disability claims, review medical documentation, and determine benefits per plan provisions. The role includes negotiating return-to-work strategies and coordinating referrals to specialists or vendors as needed.

The candidate will evaluate claims for compliance, communicate with claimants and providers, and ensure timely payments and adjustments in accordance with applicable disability plans.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices.
• Attentive understanding of Social Security procedures and disability benefits.
• Strong communication skills and ability to present information clearly.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial.
• Reviews medical information to determine disability status per the plan.
• Negotiates return to work with/without accommodations and coordinates referrals to vendors or clinician reviews.
• Monitors claims for compliance with duration guidelines and plan provisions.
• Maintains client relationships and delivers high-quality customer service.

Skills

ERISA regulations

Disability claims

Medical terminology

Negotiation

Communication

Analytical thinking

Team player

Education

High School Diploma or GED

Bachelor's degree preferred

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 determine benefits per plan provisions. The role includes negotiating return-to-work strategies and coordinating referrals to specialists or vendors as needed.

The candidate will evaluate claims for compliance, communicate with claimants and providers, and ensure timely payments and adjustments in accordance with applicable disability plans.