Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Iowa (LA); Hybrid; USD 26,000 - 32,000; Full time

Benefits offered by this job

Medical benefits

401k and matching

PTO

Disability and life insurance

Employee assistance

Job summary

Sedgwick Claims Management Services Ltd in the United States seeks an experienced Disability Representative Sr to manage disability cases, interpret disability plans, determine benefits, and oversee complex determinations. The role involves analyzing medical records, coordinating with providers, and ensuring timely payments and approvals.

The candidate will handle comorbidities, ADA accommodations, and referrals to specialists, ensuring adherence to duration guidelines and plan provisions while

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions
• Knowledge of state and federal FMLA regulations
• Working knowledge of medical terminology and duration management
• Excellent oral and written communication
• Proficient computer skills including MS Office
• Analytical, interpretive, and critical thinking skills

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial
• Reviews complex medical information to determine disability status
• Oversees comorbidities, concurrent plans, and ADA accommodations
• Determines benefits due and ensures timely payments/adjustments
• Communicates with claimants and providers to set expectations and gather documentation
• Coordinates referrals to outside vendors and physician reviews
• Negotiates return to work with or without accommodations
• Maintains professional client relationships and quality standards

Skills

ERISA regulations

FMLA regulations

Medical management

Communication skills

Analytical thinking

Negotiation

Microsoft Office

Teamwork

Decision making

Education

High School diploma or GED

Bachelor's degree preferred

State certification or licensing for statutory leaves

Tools

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd in the United States seeks an experienced Disability Representative Sr to manage disability cases, interpret disability plans, determine benefits, and oversee complex determinations. The role involves analyzing medical records, coordinating with providers, and ensuring timely payments and approvals.

The candidate will handle comorbidities, ADA accommodations, and referrals to specialists, ensuring adherence to duration guidelines and plan provisions while