Senior Disability Claims Specialist

Sedgwick; Eden Prairie (MN); On-site; USD 32,000 - 33,000; Full time

Benefits offered by this job

Medical, dental, vision

401k and matching

PTO

Life insurance

Employee assistance

Job summary

Sedgwick seeks a Disability Claims Examiner to determine benefits and manage complex disability cases from medical documentation. You will review attending statements, office notes, and reports to decide eligibility and coordinate referrals to outside vendors as needed.

Ideal candidates hold a HS diploma (Bachelor's preferred), at least 3 years in benefits/claims, and strong ERISA/FMLA knowledge, with excellent communication and Microsoft Office skills. Travel may be required.

Qualifications

• HS diploma or GED required; Bachelor's degree preferred.
• State certification or licensing in statutory leaves preferred or may be required by state.
• 3 years of benefits or disability case/claims experience preferred.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial.
• Reviews complex medical information to determine disability status per plan.
• Oversees comorbidities, concurrent plans, ADA accommodations, and referrals.
• Negotiates return to work with or without accommodations with providers and employers.
• Communicates with claimants and providers; ensures timely payments/adjustments.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Oral and written communication

Microsoft Office

Analytical thinking

Decision making

Negotiation skills

Independent judgment

Teamwork

Education

Bachelor's degree preferred

High School diploma or GED

Statutory leaves certification preferred

Tools

Microsoft Office

Job description

Sedgwick seeks a Disability Claims Examiner to determine benefits and manage complex disability cases from medical documentation. You will review attending statements, office notes, and reports to decide eligibility and coordinate referrals to outside vendors as needed.

Ideal candidates hold a HS diploma (Bachelor's preferred), at least 3 years in benefits/claims, and strong ERISA/FMLA knowledge, with excellent communication and Microsoft Office skills. Travel may be required.