Senior Disability Claims Specialist - Bilingual (French)

Sedgwick Claims Management Services Ltd; Dubuque (IA); On-site; USD 65,000 - 95,000; Full time

Job summary

Sedgwick is seeking a Sr Disability Representative fluent in French to manage complex disability claims, review medical documentation, determine benefits, and coordinate timely payments and adjustments. The role requires strong communication and independent decision-making.

The ideal candidate has 3 years of disability claims experience, knowledge of ERISA and FMLA regulations, and the ability to work in a busy, team-oriented environment. Travel may be required.

Qualifications

• Three (3) years of benefits or disability case/claims management experience.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices.
• Knowledge of state and federal FMLA regulations.
• 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 work in a team.

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, ADA accommodations.
• Determines benefits due pursuant to a disability plan, makes timely payments/adjustments for workers compensation, SSDI, and other offsets.
• Informs claimants of documentation required to process claims and status.
• Communicates with claimants’ providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration guidelines.
• Coordinates investigative efforts and reviews contested claims.
• Evaluates referrals to outside vendors or physician reviews.

Skills

Strong communication

Microsoft Office

Analytical thinking

Teamwork

Negotiation

Problem solving

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves

Tools

Microsoft Office

Job description

Sedgwick is seeking a Sr Disability Representative fluent in French to manage complex disability claims, review medical documentation, determine benefits, and coordinate timely payments and adjustments. The role requires strong communication and independent decision-making.

The ideal candidate has 3 years of disability claims experience, knowledge of ERISA and FMLA regulations, and the ability to work in a busy, team-oriented environment. Travel may be required.