Senior Disability Claims Strategist

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

Job summary

Sedgwick in Los Angeles seeks a Disability Claims Manager to evaluate complex disability claims based on medical documentation, determine benefits due, and arrange timely payments and adjustments per plan provisions. You will negotiate return to work with or without accommodations and coordinate with providers, vendors, and physician reviews.

You will analyze medical records, assess eligibility under ERISA and FMLA, and manage complex claims while upholding quality and customer service standards

Qualifications

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

Responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial to team lead.
• Reviews complex medical information to determine disability per plan.
• Oversees comorbidities, concurrent plans, and ADA accommodations.
• Determines benefits due and ensures timely payments/adjustments.
• Communicates with claimants and providers about process and status.
• Negotiates return to work with or without accommodations.
• Coordinates referrals to outside vendors or physician reviews.

Skills

ERISA regulations

FMLA knowledge

Medical terminology

Communication skills

Computer proficiency

Analytical thinking

Ambiguity tolerance

Organization & multitasking

Team player

Decision making

Education

High School diploma or GED

Bachelor's degree preferred

State certification/licensing in statutory leaves preferred

Job description

Sedgwick in Los Angeles seeks a Disability Claims Manager to evaluate complex disability claims based on medical documentation, determine benefits due, and arrange timely payments and adjustments per plan provisions. You will negotiate return to work with or without accommodations and coordinate with providers, vendors, and physician reviews.

You will analyze medical records, assess eligibility under ERISA and FMLA, and manage complex claims while upholding quality and customer service standards