# Disability Representative Sr **Company**: Sedgwick **Location**: Southfield, MI **Work arrangement**: hybrid **Experience**: senior **Job type**: full-time **Salary**: $22.00 - $24.00 Hourly **Category**: Human Resources **Industry**: Insurance **Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Southfield-MI/Disability-Representative-Sr_R70488?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_936bac9b-b0a ## 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. **Qualifications:** - 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:** - Ability to sit at a desk for extended periods while operating a computer and phone system. - Travel as required. **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. ## 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 - state certification or licensing in statutory leaves --- Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Southfield-MI/Disability-Representative-Sr_R70488?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)