Senior Disability Representative

Sedgwick

. Provides disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation .

Posted 11/11/2026full-timeRemote • Wisconsin • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in disability case management, including complex claim determinations and medical documentation analysis. Proficient in ERISA regulations, FMLA compliance, and effective communication with claimants and healthcare providers.

Highest-signal resume keywords

Disability Case ManagementERISA Regulations KnowledgeFMLA Regulations KnowledgeAnalytical And Critical Thinking SkillsEffective Decision-Making

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Complex Claim DeterminationMedical Documentation AnalysisBenefits AdministrationDisability Duration ManagementSocial Security Application ProceduresMicrosoft Office ProficiencyNegotiation SkillsJudgment And Decision-MakingCase AssessmentMultitasking

Soft Skills

Excellent Oral And Written CommunicationStrong Organizational SkillsAbility To Manage AmbiguityTeam CollaborationCustomer Service

Certifications & Qualifications

State Certification In Statutory Leaves

Industry Keywords

Disability ClaimsComorbiditiesADA AccommodationsClaim Status CommunicationInvestigative CoordinationFunctional Capability EvaluationsReturn To Work NegotiationQuality Program Requirements

About the role

Key responsibilities & impact

Provides disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation
Determines benefits due and makes timely payments, approvals, and adjustments
Medically manages disability claims involving comorbidities, concurrent plans, and complex ADA accommodations
Makes independent determinations to approve complex disability claims or recommends denial to the team lead
Reviews and analyzes complex medical information to determine whether claimants are disabled under the disability plan
Utilizes clinical resources in case assessment as needed
Informs claimants about required documentation, deadlines, payment information, and claim status
Communicates with claimants, providers, and clients regarding the claims process and return-to-work expectations
Coordinates investigative efforts and reviews contested claims
Refers claims for vendor services, physician advisor reviews, surveillance, independent medical evaluations, and functional capability evaluations
Negotiates return to work with or without accommodations through the claimant’s physician and employer
Refers cases to team lead and clinical case management for additional review
Maintains professional client relationships and provides customer service
Meets organizational quality program requirements
Performs other duties as assigned

Requirements

What you’ll need

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
Ability to sit at a desk for extended periods while operating a computer and phone system
Travel as required

Benefits

Comp & perks

Work-life balance
Reasonable accommodations when applicable and appropriate
Diverse, equitable, and inclusive workplace
Equal Opportunity Employer
Drug-free workplace