Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Irving (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

Sedgwick Claims Management Services Ltd in Irving, TX is seeking a Sr Disability Representative to manage disability claims end-to-end. You will review medical information, determine disability status, and ensure benefits are paid timely while coordinating with physicians and employers on return-to-work plans.

The role requires strong knowledge of ERISA and FMLA, excellent communication, and the ability to handle complex cases with discretion. Travel may be required and remote work is unlikely.

Qualifications

• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• 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.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• Proficient computer skills including working knowledge of Microsoft Office.
• Analytical, interpretive, and critical thinking skills.
• Ability to manage ambiguity and multitask.
• Strong organizational and negotiation skills.

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or recommends denial to team lead.
• Reviews and analyzes complex medical information to determine if claimant is disabled under the plan.
• Oversees comorbidities, concurrent plans, ADA accommodations, and claims outside typical guidelines.
• Determines benefits due and ensures timely payments/adjustments for workers' comp, SSDI, and offsets.
• Informs claimants of documentation needs, time frames, and claims status via phone, mail, or system.
• Communicates with providers to set expectations for return to work and accommodations.
• Coordinates referrals to outside vendors or physician reviews as needed.
• Maintains professional client relationships and adheres to quality programs.

Skills

ERISA knowledge

FMLA regulations

Medical terminology

Microsoft Office

Analytical thinking

Communication skills

Negotiation

Time management

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves preferred

Tools

Case management software

Microsoft Office

Job description

Sedgwick Claims Management Services Ltd in Irving, TX is seeking a Sr Disability Representative to manage disability claims end-to-end. You will review medical information, determine disability status, and ensure benefits are paid timely while coordinating with physicians and employers on return-to-work plans.

The role requires strong knowledge of ERISA and FMLA, excellent communication, and the ability to handle complex cases with discretion. Travel may be required and remote work is unlikely.