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-timeUnited StatesSeniorWebsite

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 coordinating return-to-work strategies while maintaining strong communication and organizational skills.

Highest-signal resume keywords

Disability Case ManagementERISA Regulations KnowledgeFMLA Regulations KnowledgeAnalytical SkillsNegotiation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim DeterminationMedical Documentation AnalysisBenefits ManagementMedical TerminologyDuration Management

Soft Skills

Excellent CommunicationOrganizational SkillsMultitasking SkillsDecision-Making SkillsTeam Collaboration

Tools & Technologies

Microsoft Office

Certifications & Qualifications

State Certification in Statutory Leaves

Industry Keywords

Disability Plan InterpretationComorbidities ManagementReturn to Work NegotiationIndependent Medical EvaluationsFunctional Capability Evaluations

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, including comorbidities, concurrent plans, and complex ADA accommodations
Coordinates investigative efforts and thoroughly reviews contested claims
Negotiates return to work with or without job accommodations
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, time frames, payment information, and claim status
Communicates with claimants, clients, and providers regarding the claims process and return-to-work expectations
Ensures compliance with duration control guidelines and plan provisions
Evaluates and arranges referrals to outside vendors or physician advisors for surveillance, independent medical evaluations, functional capability evaluations, and related activities
Refers cases to team lead and clinical case management for additional review when appropriate
Maintains professional client relationships and provides excellent customer service
Meets the organization’s quality program minimum 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 judgment 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
Caring culture
Equal Opportunity Employer
Drug-Free Workplace
Reasonable accommodations considered when applicable and appropriate