# Disability Representative Sr

**Company**: Sedgwick
**Experience**: senior
**Job type**: full-time
**Category**: Insurance
**Industry**: Insurance

**Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Dubuque-IA/Disability-Representative-Sr_R79480?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_6ed54bbe-06a

## Description

By joining Sedgwick, you'll be part of a global organisation that helps people facing unexpected challenges.

As a Disability Representative Sr, your primary purpose will be to provide disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretations.

**Key Responsibilities:**

- Make independent claim determinations to approve complex disability claims or recommend denials based on disability plans

- Review and analyse complex medical information to determine if claimants are disabled as defined by the disability plan

- Oversee additional facets of complex claims, including comorbidities, concurrent plans, and complex ADA accommodations

- Utilise clinical resources in case assessments as needed

- Determine benefits due and make timely claims payments and adjustments

- Communicate with claimants, providers, and clients throughout the claims process

- Coordinate investigative efforts and thoroughly review contested claims

- Evaluate and arrange referrals of claims to outside vendors or physician advisor reviews

- Negotiate return to work with or without job accommodations

- Refer cases to team leads and clinical case management for additional review when necessary

- Maintain professional client relationships and provide excellent customer service

**Requirements:**

- High school diploma or GED required; bachelor's degree preferred

- Three years of benefits or disability case/claims management experience or equivalent combination of education and experience

- Knowledge of ERISA regulations, disability duration and medical management practices, and Social Security application procedures

- Excellent oral and written communication skills

- Proficient computer skills, including Microsoft Office

- Analytical, interpretive, and critical thinking skills

- Ability to manage ambiguity and work in a team environment

**Work Environment:**

- Ability to sit at a desk for extended periods while operating a computer and phone system

- Travel may be required

- Consideration will be given to reasonable accommodations

## Skills

### Required
- ERISA regulations
- disability duration and medical management practices
- Social Security application procedures
- medical terminology
- Microsoft Office
- analytical skills
- interpretive skills
- critical thinking skills
- communication skills
- negotiation skills

### Nice to have
- state certification or licensing in statutory leaves
- bachelor's degree

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Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Dubuque-IA/Disability-Representative-Sr_R79480?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)