Senior Disability Claims Strategist

Sedgwick; Fallbrook (CA); On-site; USD 36,000 - 39,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with matching

Paid time off

Job summary

Sedgwick is seeking a Disability Claims Specialist to determine eligibility based on medical documentation and disability plan interpretation. You will coordinate return-to-work, manage comorbidities, and refer claims to outside vendors when needed.

The role requires 3+ years of benefits or disability claims experience, strong ERISA and FMLA knowledge, and excellent communication in a fast-paced California environment.

Qualifications

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

Responsibilities

• Makes independent claim determinations and recommends denials when appropriate.
• Reviews complex medical information to determine disability status per plan.
• Negotiates return to work with or without accommodations.
• Ensures timely payments, approvals and adjustments for workers' compensation and SSDI.
• Communicates with claimants, providers, and clients regarding status and requirements.

Skills

ERISA knowledge

FMLA knowledge

Medical terminology

Communication skills

MS Office

Analytical thinking

Negotiation

Decision making

Teamwork

Time management

Education

Bachelor’s degree

Licensing in statutory leaves

Tools

MS Office

Job description

Sedgwick is seeking a Disability Claims Specialist to determine eligibility based on medical documentation and disability plan interpretation. You will coordinate return-to-work, manage comorbidities, and refer claims to outside vendors when needed.

The role requires 3+ years of benefits or disability claims experience, strong ERISA and FMLA knowledge, and excellent communication in a fast-paced California environment.