Disability Representative Sr.

About the role

Joining Sedgwick means becoming part of a caring culture that supports growth and work-life balance. We are recognized by Newsweek as a top workplace and certified as a Great Place to Work® in financial services and insurance. Our teams collaborate both onsite and through a hybrid work arrangement, with centers of excellence located in various locations.

Responsibilities

• Makes independent claim determinations based on provided information, approving or denying claims based on the disability plan.
• Reviews and analyzes complex medical information to determine if the claimant qualifies for disability benefits as defined by the plan.
• Manages complex claims including comorbidities, concurrent plans, and complex ADA accommodations.
• Determines benefits due, makes timely payments/approvals and adjustments for various types of disability benefits.
• Communicates with claimants and their providers to set expectations regarding return to work and manages the investigative process.
• Evaluates and refers claims to external vendors or physician advisors as necessary.
• Negotiates return to work plans with claimants and employers, and maintains professional client relationships.

Qualifications

• High school diploma or GED required, bachelor's degree preferred.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.
• Knowledge of ERISA regulations, offsets, duration management, and Social Security application procedures.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication skills, including presentation skills.
• Proficient in using Microsoft Office.
• Strong analytical, interpretive, and critical thinking skills.
• Ability to manage ambiguity and meet deadlines.