Senior Disability Representative

Sedgwick

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

Posted 10/30/2026full-timeUnited StatesSenior💰 $21 - $24 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in disability case management, including complex claim determinations and compliance with ERISA and FMLA regulations. Proficient in analyzing medical documentation and managing claims while providing excellent customer service and maintaining professional relationships.

Highest-signal resume keywords

Disability Case ManagementERISA Regulations KnowledgeFMLA Regulations KnowledgeAnalytical And Critical Thinking SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Complex Claim DeterminationMedical Documentation AnalysisBenefits AdministrationDuration ManagementStatutory Leaves CertificationSocial Security Application ProceduresMicrosoft Office ProficiencyNegotiation SkillsDecision-Making SkillsClaims Management Experience

Soft Skills

Organizational SkillsMultitasking SkillsTeam CollaborationCustomer Service OrientationAbility To Manage Ambiguity

Certifications & Qualifications

State Certification In Statutory Leaves

Industry Keywords

Disability ClaimsMedical Management PracticesComorbiditiesADA AccommodationsClaim Investigations

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
Reviews and analyzes complex medical information to determine disability status
Oversees complex claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines
Utilizes clinical resources in case assessment
Informs claimants about required documentation, time frames, payment information, and claim status
Communicates with claimants' providers regarding return-to-work expectations
Medically manages complex disability claims for compliance with duration control guidelines and plan provisions
Communicates with claimants and clients throughout the claims process
Coordinates investigations and reviews contested claims
Refers claims to outside vendors or physician advisors for reviews, surveillance, independent medical evaluations, functional capability evaluations, or related activities
Negotiates return to work with or without accommodations through the claimant's physician and employer
Refers cases for additional review when appropriate
Maintains professional client relationships and provides excellent customer service
Meets organizational quality program requirements
Performs other duties as assigned

Requirements

What you’ll need

High School diploma or GED required
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred
State certification or licensing in statutory leaves may be required based on state regulations
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

Medical insurance
Dental insurance
Vision insurance
401k and matching
PTO
Disability insurance
Life insurance
Employee assistance
Flexible spending account or health savings account
Additional voluntary benefits
Reasonable accommodations when applicable and appropriate