Senior Disability Claims Specialist (Hybrid)

NADR; Dublin (OH); Hybrid; USD 32,000 - 34,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401k with match

PTO

Disability insurance

Life insurance

Employee assistance program

Health Savings Account

Job summary

Sedgwick is hiring for a Disability Representative Sr. in Dublin, OH. The role focuses on disability case management, making determinations based on medical documentation and plan interpretation, and coordinating referrals as needed.

The candidate will review complex medical information, determine benefits, and ensure timely payments while communicating with claimants and providers. Strong knowledge of ERISA and FMLA is essential.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices.
• Knowledge of state and federal FMLA regulations.
• Working knowledge of medical terminology and duration management.
• 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.
• Strong organizational and multitasking skills.
• Ability to work in a team environment.

Responsibilities

• Makes independent claim determinations, to approve complex disability claims or recommends denial based on disability plan.
• Reviews and analyzes complex medical information to determine disability status.
• Oversees complicated claims including comorbidities and ADA accommodations.
• Uses clinical resources in case assessment as needed.
• Determines benefits due and processes timely payments/adjustments.
• Communicates documentation needs and claim status to claimants.

Skills

ERISA knowledge

FMLA knowledge

Medical terminology

Excellent communication

MS Office

Analytical thinking

Team work

Decision making

Autonomy

Education

High school diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is hiring for a Disability Representative Sr. in Dublin, OH. The role focuses on disability case management, making determinations based on medical documentation and plan interpretation, and coordinating referrals as needed.

The candidate will review complex medical information, determine benefits, and ensure timely payments while communicating with claimants and providers. Strong knowledge of ERISA and FMLA is essential.