# Disability Representative Sr **Company**: Sedgwick **Location**: Indianapolis, IN **Work arrangement**: hybrid **Experience**: senior **Job type**: full-time **Salary**: $23.00 - $25.00 USD Hourly **Category**: Insurance **Industry**: Insurance **Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Indianapolis-IN/Disability-Representative-Sr_R70500?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_39f84731-0dc ## 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:** - 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 to determine if the claimant is disabled as defined by the disability plan. - Oversees additional facets of complex claims including comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. - Utilizes the appropriate clinical resources in case assessment 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. - 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. - Meets the organization's quality program(s) minimum requirements. **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. - 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:** - Hybrid work arrangement with onsite collaboration. - Must live near one of our centers of excellence: Indianapolis, IN. **Benefits:** - Comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The salary range for this role is $23.00 - $25.00 USD Hourly. ## Skills ### Required - ERISA regulations - disability duration and medical management practices - Social Security application procedures - state and federal FMLA regulations - medical terminology - Microsoft Office - analytical skills - interpretive skills - critical thinking skills - decision-making skills - negotiation skills ### Nice to have - Bachelor's degree - three years of benefits or disability case/claims management experience --- Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Indianapolis-IN/Disability-Representative-Sr_R70500?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)