Senior Disability Claims Specialist

Sedgwick; Wisconsin; On-site; USD 70,000 - 90,000; Full time

Job summary

Sedgwick is seeking a Sr. Disability Representative to manage complex disability claims, determine benefits, and coordinate accommodations. You will review medical documentation, ensure timely payments, and communicate with claimants and providers throughout the process.

The role emphasizes independent decision-making, adherence to ERISA and FMLA regulations, and collaboration with teams and vendors to support clients’ disability programs.

Qualifications

• Three years of benefits or disability case/claims management experience.
• Bachelor's degree preferred or equivalent experience.
• Knowledge of ERISA, FMLA, and Social Security procedures.

Responsibilities

• Make independent claim determinations to approve complex disability claims or recommend denial.
• Review complex medical information to determine disability status.
• Coordinate ADA accommodations and return-to-work plans.
• Determine benefits due and ensure timely payments/adjustments.
• Communicate requirements and status to claimants and providers.
• Coordinate referrals to outside vendors and physician reviews.
• Maintain client relationships and meet quality program requirements.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

MS Office

Analytical thinking

Ambiguity management

Multitasking

Teamwork

Performance standards

Negotiation

Autonomy

Education

High School diploma or GED

Bachelor's degree preferred

Certification/licensing in statutory leaves

Tools

Microsoft Office

Job description

Sedgwick is seeking a Sr. Disability Representative to manage complex disability claims, determine benefits, and coordinate accommodations. You will review medical documentation, ensure timely payments, and communicate with claimants and providers throughout the process.

The role emphasizes independent decision-making, adherence to ERISA and FMLA regulations, and collaboration with teams and vendors to support clients’ disability programs.