Disability Representative Sr

Sedgwick•Dubuque, IA

7d•$21 - $29•Hybrid

About The Position

The Senior Disability Representative provides disability case management and makes complex claim determinations based on medical documentation and interpretation of applicable disability plans. The role determines benefits due, makes timely payments, approvals, and adjustments, and medically manages complex claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines. The representative coordinates investigations, reviews contested claims, negotiates return-to-work plans with or without accommodations, and evaluates and arranges referrals to outside vendors and clinical resources. This role requires collaboration with claimants, clients, providers, employers, team leads, and clinical case management. Sedgwick’s teams collaborate onsite in a hybrid arrangement; candidates must live near one of the listed centers of excellence: Dubuque, Cedar Rapids, Coralville, Dublin, New Albany, Chicago, Indianapolis, Irving, Memphis, Southfield, Orlando, Eden Prairie, or West Hills. A high school diploma or GED is required; a bachelor's degree and relevant state certification or licensing are preferred, with licensing potentially required by state regulations. Three years of benefits or disability case/claims management experience, or an equivalent combination of education and experience, is preferred. The listed starting pay range for the jurisdiction covered by the posting is $20.78–$29.09 per hour. Benefits include medical, dental, and vision coverage, a 401(k) with matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings accounts, and other voluntary benefits.

Requirements

High school diploma or GED.
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 skills, 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 program performance competencies.
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.

Nice To Haves

Bachelor’s degree from an accredited university or college.
State certification or licensing in statutory leaves; may be required depending on state regulations.
Three years of benefits or disability case/claims management experience, or an equivalent combination of education and experience.

Responsibilities

Make independent determinations to approve complex disability claims, or recommend denial to a team lead based on the disability plan.
Review and analyze complex medical documentation to determine whether a claimant meets the disability plan’s definition of disability.
Oversee complex claim factors, including comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines.
Use appropriate clinical resources, such as duration guidelines and in-house clinicians, in case assessments as needed.
Determine benefits due under disability plans and make timely payments, approvals, and adjustments involving workers’ compensation, SSDI, and other disability offsets.
Inform claimants about required documentation, time frames, payment information, and claim status by phone, written correspondence, or claims system.
Communicate with claimants’ providers to set expectations regarding return to work.
Medically manage complex disability claims in compliance with duration control guidelines and plan provisions.
Communicate clearly and promptly with claimants and clients about all aspects of the claims process.
Coordinate appropriate investigative efforts and thoroughly review contested claims.
Evaluate and arrange referrals to outside vendors or physician advisor reviews, surveillance, independent medical evaluations, functional capability evaluations, or related disability activities.
Negotiate return to work, with or without job accommodations, through the claimant’s physician and employer.
Refer cases to a team lead and clinical case management for additional review when appropriate.
Maintain professional client relationships and provide excellent customer service.
Meet the organization’s minimum quality program requirements.
Perform other duties as assigned.