Senior Disability Claims Specialist - Hybrid

Sedgwick Claims Management Services Ltd; Southfield (MI); Ibrido; USD 65.000 - 90.000; Tempo pieno

Descrizione del lavoro

Sedgwick Claims Management Services Ltd in Southfield, MI, seeks a Senior Disability Representative to manage complex disability claims based on medical documentation and plan interpretation. You'll determine benefits due and ensure timely payments, with oversight of comorbidities and ADA accommodations.

The role requires knowledge of ERISA, FMLA, medical terminology, and strong communication. You will collaborate with providers and clients, aiming for accurate decisions and timely resolutions

Competenze

• High School diploma or GED required; Bachelor’s degree preferred.
• State certification/licensing in statutory leaves preferred or may be required by state regulations.
• Three years of benefits or disability case/claims management experience preferred.

Mansioni

• Makes independent claim determinations to approve complex disability claims or recommends denial as needed.
• Reviews complex medical information to determine disability status per plan definitions.
• Oversees comorbidities, concurrent plans, and ADA accommodations within complex claims.
• Negotiates return to work with or without accommodations with physicians and employers.

Conoscenze

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

MS Office

Analytical thinking

Problem solving

Team player

Negotiation

Formazione

High school diploma or GED

Bachelor’s degree preferred

Strumenti

Microsoft Office

Descrizione del lavoro

Sedgwick Claims Management Services Ltd in Southfield, MI, seeks a Senior Disability Representative to manage complex disability claims based on medical documentation and plan interpretation. You'll determine benefits due and ensure timely payments, with oversight of comorbidities and ADA accommodations.

The role requires knowledge of ERISA, FMLA, medical terminology, and strong communication. You will collaborate with providers and clients, aiming for accurate decisions and timely resolutions