Senior Disability Claims Specialist – Complex Cases

Sedgwick; Dubuque (IA); On-site; USD 65,000 - 90,000; Full time

Job summary

Sedgwick in the United States is seeking a Senior Disability Representative to oversee complex disability claims, interpret disability plans, and ensure timely payments and approvals.

You will review medical documentation, negotiate return-to-work with or without accommodations, coordinate referrals to outside vendors, and maintain professional client relationships while meeting organizational quality standards. This role requires strong analytical, communication, and negotiation skills.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management.
• Knowledge of state and federal FMLA regulations.
• Strong communication and analytical abilities; professional presentation skills.

Responsibilities

• Makes independent claim determinations for complex disability claims or recommends denial per plan.
• Reviews complex medical information to determine disability status per plan.
• Negotiates return to work with or without accommodations with providers and employers.
• Coordinates referrals to outside vendors or physician reviews as needed.
• Maintains professional client relationships and ensures quality program compliance.

Skills

ERISA regulations knowledge

Disability duration management

Negotiation skills

Analytical thinking

Effective written/oral communication

Education

Bachelor's degree preferred

High School diploma or GED required

Tools

Microsoft Office

Claims processing software

Job description

Sedgwick in the United States is seeking a Senior Disability Representative to oversee complex disability claims, interpret disability plans, and ensure timely payments and approvals.

You will review medical documentation, negotiate return-to-work with or without accommodations, coordinate referrals to outside vendors, and maintain professional client relationships while meeting organizational quality standards. This role requires strong analytical, communication, and negotiation skills.