Senior Disability Claims Specialist – Complex Case Management

Sedgwick Claims Management Services Ltd; Los Angeles, Fallbrook (CA, CA); On-site; USD 36,000 - 39,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision plan

401k with match

PTO

Disability insurance

Life insurance

Employee assistance

FSA/HSA

Job summary

Sedgwick is seeking a Sr. Disability Representative in Los Angeles to manage disability claims from intake through payment and closure. The role requires analyzing medical documentation, applying plan interpretations, and coordinating with clinicians and vendors to resolve complex cases.

The position emphasizes collaboration, adherence to ERISA and FMLA guidelines, and timely return-to-work decisions while maintaining high service standards and regulatory compliance.

Qualifications

• Knowledge of ERISA regulations, offsets and deductions, and disability management practices.
• Familiar with state and federal FMLA regulations.
• Working knowledge of medical terminology and disability duration management.

Responsibilities

• Make independent claim determinations to approve complex disability claims.
• Review complex medical information to determine disability status per plan.
• Oversee complex claims including comorbidities and ADA accommodations.
• Determine benefits due and ensure timely payments and adjustments.
• Communicate with claimants and providers about requirements and status.
• Coordinate investigations and referrals to vendors or physician reviews.
• Negotiate return-to-work with or without accommodations.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Oral & written communication

Microsoft Office

Analytical thinking

Teamwork

Decision-making

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves preferred

Tools

Microsoft Office

Job description

Sedgwick is seeking a Sr. Disability Representative in Los Angeles to manage disability claims from intake through payment and closure. The role requires analyzing medical documentation, applying plan interpretations, and coordinating with clinicians and vendors to resolve complex cases.

The position emphasizes collaboration, adherence to ERISA and FMLA guidelines, and timely return-to-work decisions while maintaining high service standards and regulatory compliance.