Senior Disability Claims Specialist - Hybrid Orlando

Miami Neuroscience Institute Baptist Health South Florida; Orlando (FL); Hybrid; USD 27,000 - 32,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Sedgwick in Orlando, FL is hiring a Disability Representative Sr to manage complex disability claims with medical documentation and plan interpretation. You will determine benefits, coordinate care, supervise investigations, and facilitate return-to-work strategies in a hybrid onsite model near Orlando centers.

Key duties include reviewing medical information, negotiating settlements, and ensuring timely payments while upholding quality standards and customer service expectations.

Qualifications

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
• 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
• Ability to meet or exceed performance competencies as required by program
• Effective decision-making and negotiation skills
• Ability to exercise judgement autonomously within established procedures

Responsibilities

• Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Communicates with claimants and providers to set expectations regarding return to work.
• Determines benefits due and makes timely payments/adjustments for workers' compensation, SSDI, and other offsets.
• Coordinates investigative efforts and referrals to outside vendors or physician reviews.

Skills

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Ambiguity management

Organization

Teamwork

Decision-making

Judgement autonomously

Education

High School diploma

Bachelor's degree preferred

State certification/licensing in statutory leaves preferred

Tools

Microsoft Office

Job description

Sedgwick in Orlando, FL is hiring a Disability Representative Sr to manage complex disability claims with medical documentation and plan interpretation. You will determine benefits, coordinate care, supervise investigations, and facilitate return-to-work strategies in a hybrid onsite model near Orlando centers.

Key duties include reviewing medical information, negotiating settlements, and ensuring timely payments while upholding quality standards and customer service expectations.