Sedgwick
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Sr Disability Representative
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Sedgwick By joining Sedgwick, you’ll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work‑life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplace Certified as a Great Place to Work® Fortune Best Workplace in Financial Services & Insurance Our Teams Connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence. Primary Purpose
Provides disability case management and complex claim determinations based on medical documentation and the 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, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors. Locations
Dubuque, IA – 4141 Westmark Drive Cedar Rapids, IA – 333 1st Street SE Ste. 200 Coralville, IA – 3273 Ridgeway Drive Dublin, OH – 5500 Glendon Court New Albany, OH – 7795 Walton Parkway Chicago, IL – 175 W. Jackson Blvd. 12th Fl. Indianapolis, IN – 8909 Purdue Road Suite 501 Irving, TX – 2201 W. Royal Lane Suite 125 Memphis, TN – 8125 Sedgwick Way Southfield, MI – 300 Galleria Officentre Orlando, FL – 12650 Ingenuity Dr Eden Prairie, MN – 11000 Prairie Lakes Drive West Hills, CA – 8521 Fallbrook Ave Essential Functions and Responsibilities
Make independent claim determinations to approve complex disability claims or recommend denial based on the disability plan. Review and analyze complex medical information to determine disability status as defined by the plan. Oversee additional facets of complex claims, including comorbidities, concurrent plans, complex ADA accommodations. Utilize appropriate clinical resources in case assessment as needed. Determine benefits due, make timely payments/approvals and adjustments for workers compensation, SSDI, and other offsets. Inform claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system. Communicate with claimants’ providers to set expectations regarding return to work. Medically manage complex disability claims ensuring compliance with duration control guidelines and plan provisions. Communicate clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system. Coordinate investigative efforts ensuring appropriateness; provide thorough review of contested claims. Evaluate and arrange appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and related disability activities. Negotiate return to work with or without job accommodations via the claimant’s physician and employer. Refer cases to team lead and clinical case management for additional review when appropriate. Maintain professional client relationships and provide excellent customer service. Meet the organization’s quality program(s) minimum requirements. Additional Functions and Responsibilities
Perform other duties as assigned. Qualifications
Education & Licensing
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. Experience
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. Skills & Knowledge
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. Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required. Hearing, vision and talking. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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Sr Disability Representative
role at
Sedgwick By joining Sedgwick, you’ll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work‑life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplace Certified as a Great Place to Work® Fortune Best Workplace in Financial Services & Insurance Our Teams Connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence. Primary Purpose
Provides disability case management and complex claim determinations based on medical documentation and the 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, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors. Locations
Dubuque, IA – 4141 Westmark Drive Cedar Rapids, IA – 333 1st Street SE Ste. 200 Coralville, IA – 3273 Ridgeway Drive Dublin, OH – 5500 Glendon Court New Albany, OH – 7795 Walton Parkway Chicago, IL – 175 W. Jackson Blvd. 12th Fl. Indianapolis, IN – 8909 Purdue Road Suite 501 Irving, TX – 2201 W. Royal Lane Suite 125 Memphis, TN – 8125 Sedgwick Way Southfield, MI – 300 Galleria Officentre Orlando, FL – 12650 Ingenuity Dr Eden Prairie, MN – 11000 Prairie Lakes Drive West Hills, CA – 8521 Fallbrook Ave Essential Functions and Responsibilities
Make independent claim determinations to approve complex disability claims or recommend denial based on the disability plan. Review and analyze complex medical information to determine disability status as defined by the plan. Oversee additional facets of complex claims, including comorbidities, concurrent plans, complex ADA accommodations. Utilize appropriate clinical resources in case assessment as needed. Determine benefits due, make timely payments/approvals and adjustments for workers compensation, SSDI, and other offsets. Inform claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system. Communicate with claimants’ providers to set expectations regarding return to work. Medically manage complex disability claims ensuring compliance with duration control guidelines and plan provisions. Communicate clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system. Coordinate investigative efforts ensuring appropriateness; provide thorough review of contested claims. Evaluate and arrange appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and related disability activities. Negotiate return to work with or without job accommodations via the claimant’s physician and employer. Refer cases to team lead and clinical case management for additional review when appropriate. Maintain professional client relationships and provide excellent customer service. Meet the organization’s quality program(s) minimum requirements. Additional Functions and Responsibilities
Perform other duties as assigned. Qualifications
Education & Licensing
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. Experience
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. Skills & Knowledge
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. Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required. Hearing, vision and talking. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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