# Disability Representative Sr **Company**: Sedgwick **Location**: Telecommuter, WI **Experience**: senior **Job type**: full-time **Category**: Insurance **Industry**: Insurance **Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Telecommuter-WI/Disability-Representative-Sr_R80362?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/disability-representative-sr-30943c06-32c/ ## Description 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. As a Disability Representative Sr, you will provide disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation. **Responsibilities:** - Make independent claim determinations, based on the information received, to approve complex disability claims or make recommendations to team lead to deny claims based on the disability plan. - Review and analyze complex medical information to determine if the claimant is disabled as defined by the disability plan. - Oversee additional facets of complex claims, including comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. - Utilize clinical resources in case assessment as needed. - Determine benefits due pursuant to a disability plan, make timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. - Inform claimants of documentation required to process claims, required time frames, payment information, and claims status. - 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. - Coordinate investigative efforts, thoroughly review contested claims, negotiate return to work with or without job accommodations, and evaluate and arrange appropriate referral of claims to outside vendors. **Requirements:** - High school diploma or GED required; bachelor's degree from an accredited university or college preferred. - 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. - 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, and ability to work in a team environment. For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - ERISA regulations - disability duration and medical management practices - Social Security application procedures - Microsoft Office - analytical skills - communication skills ### Nice to have - bachelor's degree - state certification or licensing in statutory leaves --- Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Telecommuter-WI/Disability-Representative-Sr_R80362?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)