Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Dubuque (IA); On-site; USD 65,000 - 90,000; Full time

Job summary

Sedgwick Claims Management Services Ltd in Dubuque, IA, is seeking a Senior Disability Representative to evaluate complex disability claims using medical data and plan provisions. You will determine benefits due, authorize payments, and coordinate vendor referrals as needed.

The role requires knowledge of ERISA, FMLA, SSDI, and durable negotiations for return to work with or without accommodations, plus strong communication, analytical, and multitasking skills.

Qualifications

• 3 years in benefits or disability case/claims management experience.
• Knowledge of ERISA regulations, required offsets and deductions, and disability duration.
• Knowledge of FMLA regulations and SSDI processes.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• Proficient with Microsoft Office and data/document handling.
• Analytical, interpretive, and critical thinking abilities.
• Ability to work in a team and manage multiple priorities.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial to team lead.
• Reviews and analyzes complex medical information to determine disability status per plan.
• Oversees comorbidities, concurrent plans, ADA accommodations, and nonstandard claims.
• Determines benefits due, and makes timely payments/adjustments for workers' comp and SSDI.
• Informs claimants of documentation, time frames, and payment status by phone or claims system.
• Communicates with providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring duration guideline compliance.
• Coordinates investigations and reviews contested claims; refers to outside vendors when needed.
• Negotiates return to work with or without accommodations with physicians and employers.
• Refers complex cases to team lead and clinical review; maintains client relationships and service quality.

Skills

ERISA regulations

FMLA regulations

Disability case management

Medical terminology

Analytical thinking

Communication skills

Microsoft Office

Negotiation skills

Teamwork

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing for statutory leaves preferred

Tools

Microsoft Office Suite

Job description

Sedgwick Claims Management Services Ltd in Dubuque, IA, is seeking a Senior Disability Representative to evaluate complex disability claims using medical data and plan provisions. You will determine benefits due, authorize payments, and coordinate vendor referrals as needed.

The role requires knowledge of ERISA, FMLA, SSDI, and durable negotiations for return to work with or without accommodations, plus strong communication, analytical, and multitasking skills.