Senior Disability Claims Specialist | Impactful Case Work

NADR; Dubuque (IA); On-site; USD 60,000 - 90,000; Full time

Job summary

Sedgwick is hiring a Disability Case Manager to evaluate complex claims using medical documentation and disability plan interpretation. You will determine benefits due, arrange timely payments, and coordinate return-to-work strategies with clients and providers.

The role requires reviewing medical information, applying ERISA and FMLA standards, and negotiating accommodations while upholding quality and compliance across cases.

Qualifications

• Three years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• 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
• Excellent oral and written communication, including presentation skills
• Proficient computer skills including working knowledge of Microsoft Office

Responsibilities

• Makes independent claim determinations 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, ADA accommodations, and claims outside of typical guidelines.
• Utilizes the appropriate clinical resources in case assessment, as needed.
• Determines benefits due pursuant to a disability plan and makes timely payments/adjustments for workers compensation, SSDI, and other offsets.
• Informs claimants of documentation required to process claims and provides status updates.
• Communicates with claimants' providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration guidelines and plan provisions.
• Negotiates return to work with or without accommodations via the claimant's physician and employer.
• Maintains professional client relationships and provides excellent customer service.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Communication skills

Microsoft Office

Analytical thinking

Problem solving

Teamwork

Decision making

Negotiation skills

Autonomous judgment

Education

High School diploma or GED

Bachelor's degree preferred

Tools

Claims management software

Job description

Sedgwick is hiring a Disability Case Manager to evaluate complex claims using medical documentation and disability plan interpretation. You will determine benefits due, arrange timely payments, and coordinate return-to-work strategies with clients and providers.

The role requires reviewing medical information, applying ERISA and FMLA standards, and negotiating accommodations while upholding quality and compliance across cases.