Senior Disability Claims Specialist

Sedgwick Claims Management Services Ltd; Los Angeles (CA); On-site; USD 34,000 - 37,000; Full time

Benefits offered by this job

Medical, dental, vision

401k and matching

PTO

Disability and life insurance

Employee assistance

Flexible spending or health savings

Job summary

Sedgwick Claims Management Services Ltd is seeking a Sr Disability Representative to manage complex disability claims and make determinations based on medical documentation and plan interpretation. You will coordinate investigations, evaluate referrals to vendors, and negotiate return-to-work arrangements with clinicians and employers.

The role requires analyzing medical information, ensuring benefits are paid accurately, and maintaining clear communication with claimants and clients.

Qualifications

• High School diploma or GED; bachelor’s degree preferred.
• Three years of benefits or disability case/claims management experience.
• Knowledge of ERISA, FMLA, and Social Security procedures.

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial when appropriate.
• Reviews complex medical information to determine disability status per plan definitions.
• Manages comorbidities, concurrent plans, and ADA accommodations within claims.
• Determines benefits due and ensures timely payments/adjustments.
• Negotiates return to work with or without accommodations, coordinating with providers.
• Communicates with claimants and providers regarding process, status, and requirements.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Analytical thinking

Microsoft Office

Decision-making

Negotiation

Education

High School diploma or GED

Bachelor's degree (preferred)

Job description

Sedgwick Claims Management Services Ltd is seeking a Sr Disability Representative to manage complex disability claims and make determinations based on medical documentation and plan interpretation. You will coordinate investigations, evaluate referrals to vendors, and negotiate return-to-work arrangements with clinicians and employers.

The role requires analyzing medical information, ensuring benefits are paid accurately, and maintaining clear communication with claimants and clients.