Disability Representative Sr.

By joining Sedgwick, you'll be part of something truly meaningful. Itu2019s 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, thereu2019s no limit to what you can achieve. Newsweek Recognizes Sedgwick as Americau2019s Greatest Workplaces National Top Companies Certified as a Great Place to Worku00ae Fortune Best Workplaces in Financial Services & Insurance Disability Representative Sr. Senior Disability Representative u2013 Make a Meaningful Impact Location: Hybrid work model with in-office collaboration. Candidates must reside near one of our Centers of Excellence. Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002 Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401 Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241 Dublin, OH : 5500 Glendon Court Dublin OH 43016 New Albany, OH : 7795 Walton Parkway New Albany, OH 43054 Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604 Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268 Irving, TX : 2201 W. Royal Lane Suite 125 Irving, TX 75063 Memphis, TN : 8125 Sedgwick Way, Memphis TN 38125 Southfield, MI : 300 Galleria Officentre Southfield MI 48034 Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826 Eden Prairie, MN : 11000 Prairie Lakes Drive Eden Prairie, MN 55344 West Hills, CA : 8521 Fallbrook Ave West Hills, CA 91304 PRIMARY PURPOSE : At Sedgwick, caring counts . Weu2019re a global leader in claims management, and weu2019re looking for experienced, compassionate professionals to join us as Senior Disability Representatives . If youu2019re someone who thrives in a collaborative environment, values integrity, and wants to make a real difference in peopleu2019s livesu2014this is your opportunity. What Youu2019ll Do As a Senior Disability Representative, youu2019ll be a trusted guide for individuals navigating complex disability claims. Youu2019ll use your expertise to assess medical documentation, determine benefits, and support return-to-work strategiesu2014all while delivering exceptional service with empathy and precision. Key responsibilities include: Independently evaluating and managing complex disability claims. Interpreting medical records and disability plans to determine eligibility. Handling claims involving comorbidities, ADA accommodations, and concurrent plans. Collaborating with healthcare providers and employers to facilitate return-to-work. Communicating clearly and compassionately with claimants and clients. Coordinating investigative efforts and referrals to external vendors when needed. Maintaining strong client relationships and upholding Sedgwicku2019s quality standards. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Independently evaluates complex disability claims and makes approval decisions based on received documentation, or recommends denial to the team lead in alignment with the disability plan. Carefully reviews and interprets detailed medical recordsu2014including attending physician statements, office notes, and operative reportsu2014to assess whether the claimant meets the planu2019s definition of disability. Oversees multifaceted claims involving comorbid conditions, overlapping benefit plans, ADA accommodations, and cases that fall outside standard guidelines. Applies clinical resources such as duration guidelines and consults with in-house clinicians to support case assessments when necessary. Calculates benefits due under the disability plan and ensures timely processing of payments, approvals, and adjustmentsu2014including offsets for workersu2019 compensation, Social Security Disability Income (SSDI), and other applicable sources. Clearly communicates with claimants regarding required documentation, timelines, payment details, and claim status through phone calls, written correspondence, and system updates. Engages with healthcare providers to establish expectations for return-to-work timelines and accommodations. Manages complex disability claims with a focus on medical compliance, duration control, and adherence to plan provisions. Maintains consistent and transparent communication with claimants and clients throughout the claims process via phone, written updates, and system documentation. Coordinates investigative efforts to ensure thorough and appropriate claim reviews. Identifies when claims require external support and arranges referrals to vendors for services such as physician advisor reviews, surveillance, independent medical evaluations, and functional capability assessments. Facilitates return-to-work negotiations with or without accommodations, collaborating with the claimantu2019s physician and employer. Escalates cases to the team lead or clinical case management for further review when appropriate. Builds and maintains professional relationships with clients, delivering high-quality customer service. Meets or exceeds the organizationu2019s quality standards and program requirements. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. QUALIFICATIONS Education & Licensing High school diploma or GED is required. Bacheloru2019s degree from an accredited college or university is preferred. State certification or licensing in statutory leaves is preferred or may be required depending on local regulations. Experience Preferred: Three (3) years of experience in benefits or disability case/claims management, or an equivalent combination of education and experience. Skills & Knowledge Solid understanding of ERISA regulations, disability offsets and deductions, medical management practices, and Social Security Disability application procedures. Familiarity with federal and state FMLA regulations. Working knowledge of medical terminology and duration management. Strong verbal and written communication skills, including the ability to present information clearly. Proficiency in Microsoft Office and general computer systems. Analytical mindset with strong interpretive and critical thinking abilities. Comfortable navigating ambiguity and making informed decisions. Excellent organizational and multitasking capabilities. Collaborative team player with a commitment to performance excellence. Skilled in negotiation and autonomous decision-making within established procedures. Ability to exercise sound judgment and maintain discretion. WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental : 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 Physical : Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required. Auditory/Visual : Hearing, vision and talking Ready to Make a Difference? Apply today and become part of a team thatu2019s redefining care and support in the workplace. At Sedgwick, your work mattersu2014and so do you. 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. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $20.39 - $24.00 USD Hourly_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angelesu2019 Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Sedgwick is the worldu2019s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companyu2019s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see

Created: 2025-11-15