Senior Disability Claims Specialist

Sedgwick; Irving (TX); On-site; USD 75,000 - 100,000; Full time

Job summary

Sedgwick is hiring a Senior Disability Representative to manage complex disability claims. You will assess medical information, determine eligibility, and coordinate return-to-work with employers and providers, ensuring timely benefits and compliant decisions.

The role emphasizes ERISA expertise, ADA accommodations, and accurate documentation, while collaborating across teams to uphold service quality and regulatory standards.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
• Knowledge of state and federal FMLA regulations
• Excellent oral and written communication, including presentation skills

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial based on the plan.
• Reviews and analyzes complex medical information to determine disability status as defined by the plan.
• Oversees comorbidities, concurrent plans, ADA accommodations, and claims outside typical guidelines.
• Utilizes clinical resources in case assessment as needed.
• Determines benefits due, makes timely payments/adjustments for disability offsets.
• Informs claimants of required documentation, time frames, and status by phone or claims system.
• Communicates with claimants’ providers to set return-to-work expectations.
• Manages complex disability claims ensuring compliance with duration guidelines.
• Coordinates referrals to outside vendors or clinician reviews and related activities.
• Negotiates return to work with or without accommodations with the physician and employer.

Skills

ERISA knowledge

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Organization & multitasking

Teamwork

Decision making

Negotiation

Education

High school diploma or GED

Bachelor's degree preferred

State certification/licensing for statutory leaves preferred

Job description

Sedgwick is hiring a Senior Disability Representative to manage complex disability claims. You will assess medical information, determine eligibility, and coordinate return-to-work with employers and providers, ensuring timely benefits and compliant decisions.

The role emphasizes ERISA expertise, ADA accommodations, and accurate documentation, while collaborating across teams to uphold service quality and regulatory standards.