Senior Disability Claims Specialist - Complex Case Mgmt

NADR; Orlando (FL); Presencial; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

Sedgwick is seeking a Disability Representative Sr to perform disability case management based on medical documentation and plan interpretation. You will determine benefits, coordinate with providers, and manage complex claims including accommodations and referrals.

Strong analytical and communication skills are essential. Ideal candidates have a background in ERISA/ADA regulations, and experience in benefits or disability claims.

Formación

• High School diploma or GED required; Bachelor's degree preferred or may be required by state regulations.
• Three years of benefits or disability case/claims management experience or equivalent.
• Knowledge of ERISA, FMLA, and disability duration/medical management.
• Excellent verbal and written communication; proficient computer skills.

Responsabilidades

• Make independent claim determinations to approve complex disability claims or recommend denial.
• Review complex medical information to determine disability status per plan definitions.
• Coordinate with providers and claimants to set expectations and return-to-work arrangements.
• Manage complex claims including ad hoc referrals, comorbidities, and ADA accommodations.
• Ensure timely payments/adjustments and compliance with plan provisions.

Conocimientos

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Decision making

Negotiation skills

Autonomy

Teamwork

Educación

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves preferred

Herramientas

Microsoft Office

Descripción del empleo

Sedgwick is seeking a Disability Representative Sr to perform disability case management based on medical documentation and plan interpretation. You will determine benefits, coordinate with providers, and manage complex claims including accommodations and referrals.

Strong analytical and communication skills are essential. Ideal candidates have a background in ERISA/ADA regulations, and experience in benefits or disability claims.