Senior Disability Representative

Jobtailor; Iowa (LA); On-site; USD 60,000 - 90,000; Full time

Job summary

Jobtailor is seeking a skilled disability claims professional to manage complex cases end-to-end, interpret disability plans, and approve payments. You will review medical documentation, coordinate with providers, negotiate return-to-work, and ensure compliance with ERISA and FMLA regulations while delivering excellent client service.

Ideal candidates will bring 3+ years of disability claims experience, strong analytical and communication skills, and proficiency in Microsoft Office to support

Qualifications

• High School diploma or GED required.
• Bachelor's degree preferred.
• State certification/licensing in statutory leaves preferred or may be required based on state regulations.
• Three (3) 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.
• 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

• Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments.
• Medically manages disability claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.
• 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 (attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.
• Utilizes appropriate clinical resources in case assessment (duration guidelines, in‑house clinicians) as needed.
• Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers’ compensation, Social Security Disability Income (SSDI), and other disability offsets.
• Informs claimants of documentation required to process claims, required time frames, payment information, and claims status by phone, written correspondence, and/or claims system.
• Communicates with claimants’ providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
• Communicates clearly and timely with claimant and client on all aspects of the claims process by phone, written correspondence, and/or claims system.
• Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
• Negotiates return to work with or without job accommodations via the claimant’s physician and employer.
• Refs cases to team lead and clinical case management for additional review when appropriate.
• Maintains professional client relationships and provides excellent customer service.

Skills

Disability claims

ERISA knowledge

FMLA knowledge

MS Office

Analytical thinking

Communication skills

Negotiation

Teamwork

Independent decisions

Education

High School diploma

Bachelor's degree

State certification/licensing in statutory leaves

Tools

Microsoft Office

Job description

Responsibilities

• Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments.
• Medically manages disability claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.
• 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 (attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
• Oversees additional facets of complex claims including comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.
• Utilizes appropriate clinical resources in case assessment (duration guidelines, in‑house clinicians) as needed.
• Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers’ compensation, Social Security Disability Income (SSDI), and other disability offsets.
• Informs claimants of documentation required to process claims, required time frames, payment information, and claims status by phone, written correspondence, and/or claims system.
• Communicates with claimants’ providers to set expectations regarding return to work.
• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
• Communicates clearly and timely with claimant and client on all aspects of the claims process by phone, written correspondence, and/or claims system.
• Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
• Negotiates return to work with or without job accommodations via the claimant’s physician and employer.
• Refs cases to team lead and clinical case management for additional review when appropriate.
• Maintains professional client relationships and provides excellent customer service.

Requirements

• High School diploma or GED required.
• Bachelor's degree from an accredited university or college preferred.
• State certification or licensing in statutory leaves is preferred or may be required based on state regulations.
• Three (3) 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.
• 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.