Senior Disability Representative

Sedgwick

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

Posted 9/24/2026full-timeUnited StatesSenior💰 $23 - $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in disability case management, including claim determinations, medical documentation analysis, and compliance with ERISA and FMLA regulations. Proficient in communication and negotiation skills to effectively manage claimant interactions and coordinate with healthcare providers.

Highest-signal resume keywords

Disability Case ManagementERISA Regulations KnowledgeFMLA Regulations KnowledgeAnalytical SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim DeterminationMedical Documentation AnalysisDisability Plan InterpretationBenefits ManagementMedical Terminology KnowledgeCritical ThinkingDecision-MakingNegotiation SkillsMultitaskingPerformance Competencies

Soft Skills

Organizational SkillsTeam CollaborationCustomer ServiceAbility to Manage AmbiguityPresentation Skills

Tools & Technologies

Microsoft Office

Certifications & Qualifications

State Certification in Statutory Leaves

Industry Keywords

Disability ClaimsComorbidities ManagementADA AccommodationsIndependent Medical EvaluationsFunctional Capability EvaluationsClaimant CommunicationQuality 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, including comorbidities, concurrent plans, and complex ADA accommodations
Makes independent claim determinations or recommends denial of claims to the team lead
Reviews and analyzes complex medical information to determine disability under the applicable plan
Oversees complex claim facets and utilizes appropriate clinical resources
Informs claimants of required documentation, time frames, payment information, and claim status
Communicates with claimants, clients, and providers regarding the claims process and return-to-work expectations
Coordinates investigations and reviews contested claims
Evaluates and arranges referrals to outside vendors or physician advisor reviews, surveillance, independent medical evaluations, functional capability evaluations, and related disability activities
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 excellent customer service
Meets organizational quality program minimum requirements
Performs other duties as assigned

Requirements

What you’ll need

High School diploma or GED required
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

Medical insurance
Dental insurance
Vision insurance
401k and matching
PTO
Disability insurance
Life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Reasonable accommodations
Work-life balance