Senior Disability Claims Specialist

NADR; Portland (ME); Híbrido; USD 29.000 - 40.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

401k & matching

PTO

Descripción de la vacante

Sedgwick is seeking a Sr Disability Representative to manage complex disability claims, review medical documentation, and determine benefits under the disability plan. The role involves coordinating with treating providers, performers, and clients to ensure timely decisions and appropriate accommodations.

The position requires a background in benefits or disability case management, ERISA/FMLA knowledge, and strong communication skills.

Formación

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices
• 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 Microsoft Office
• Analytical, interpretive, and critical thinking skills
• Ability to manage ambiguity
• Strong organizational and multitasking skills

Responsabilidades

• Makes independent claim determinations to approve complex disability claims or makes a denial recommendation
• Reviews complex medical information to determine disability status
• Oversees comorbidities, concurrent plans, and ADA accommodations
• Determines benefits due and ensures timely payments/adjustments
• Informs claimants of required documentation and timelines
• Communicates with providers to set expectations regarding return to work
• Medically manages complex disability claims and ensures plan compliance
• Negotiates return to work with/without accommodations
• Maintains professional client relationships and delivers excellent service
• Meets quality program requirements

Conocimientos

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Analytical thinking

Negotiation

Decision making

Teamwork

Educación

High School diploma or GED

Bachelor's degree preferred

Descripción del empleo

Sedgwick is seeking a Sr Disability Representative to manage complex disability claims, review medical documentation, and determine benefits under the disability plan. The role involves coordinating with treating providers, performers, and clients to ensure timely decisions and appropriate accommodations.

The position requires a background in benefits or disability case management, ERISA/FMLA knowledge, and strong communication skills.