Senior Disability Representative

Sedgwick

Disability Representative managing complex claims and providing case management for disability cases. Working with medical documentation to determine benefits and manage claims effectively.

Posted 6/29/2026full-timeEden Prairie • Iowa, Minnesota • 🇺🇸 United StatesSenior💰 $25 per hourWebsite

About the role

Key responsibilities & impact

Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments
Medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations
Coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors
Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan
Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan
Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines
Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed
Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system
Communicates with the claimants’ providers to set expectations regarding return to work
Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions
Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system
Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims
Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities
Negotiates return to work with or without job accommodations via the claimant’s physician and employer
Refers cases to team lead and clinical case management for additional review when appropriate
Maintains professional client relationships and provides excellent customer service

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

Benefits

Comp & perks

medical
dental
vision
401k and matching
PTO
disability and life insurance
employee assistance
flexible spending or health savings account
other additional voluntary benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claim DeterminationMedical Documentation AnalysisDisability Duration ManagementSocial Security Application ProceduresStatutory Leaves CertificationMicrosoft Office ProficiencyCritical ThinkingMultitaskingDecision-MakingJudgment Exercise

Soft Skills

Organizational SkillsTeam CollaborationCustomer ServicePresentation SkillsAbility to Manage Ambiguity

Certifications

State Certification in Statutory Leaves