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Disability Representative Sr

Sedgwick

1 Positions

ID: R59068

Posted On 04/20/2025

Refreshed On 05/03/2025

Job Overview

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Disability Representative Sr

**PRIMARY PURPOSE** : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.

ESSENTIAL FUNCTIONS and 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 (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.

+ Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.

+ Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), 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.

+ Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.

+ 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

+ Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing

High School diploma or GED required. Bachelor's degree from an accredited university or college preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations.

Experience

Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.

Skills & Knowledge

+ 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

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

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.

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.

Primary Contact

1645458383738

Amanda Strothman

,

Phone

Phone

Phone

Fax

[email protected]

Email

True

False

True

Job Details

Categories

Insurance

Technical

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

8326

Job REQ #

R59068

\# Positions

1

Start Date

20250420

End Date

20250620

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Sedgwick

About the Company

Career Development

Our goal is to make Sedgwick CMS a place where great people can do great things for our clients. This commitment is evidenced by our colleague development program and supported by our multi-dimensional learning resources.

We invest in the education of our colleagues by providing training and learning resources that focus on our culture, procedures, systems and performance expectations. We evaluate the educational needs of our colleagues through performance discussions and evaluations. These needs are filled either through Sedgwick CMS University and through industry certification programs and other external educational resources . Sedgwick CMS University curriculum offerings take colleagues from orientation to technical training to supervisory and managerial development. Through Sedgwick CMS University, we provide our colleagues continuous development of professional skills and the ability to deliver quality service to our clients.

Colleague Orientation

We offer a required colleague orientation program that allows us to verify and document the training provided to new colleagues. This program is called Personal Responsibility in Developing Excellence (PRIDE) and is the first component of our comprehensive career development process. This program introduces and orients new and transitioning colleagues to our company and to their new position. PRIDE will take colleagues through the first 90 days of their new position. Objectives of this program focus on providing colleagues an increased awareness of who we are, where we are going, and how they can help us get there.

Career Paths

Career path options are identified through an ongoing process of discussion and collaboration between colleagues and their managers. On an ongoing basis, our managers counsel colleagues regarding their career path, new opportunities, and additional training and development requirements to help them reach their individual goals.