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Skills: Disability case management, Claim determinations, Medical terminology, ERISA regulations, FMLA regulations
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$21/hr–$23/hr
Full-time
high school, bachelor degree
Medical, Dental, Vision, 401k, Paid time off, Disability insurance
Posted 3d ago
~40 hrs/week
Responsibilities
The Disability Representative manages complex disability claims by analyzing medical documentation to determine benefit eligibility and payment adjustments. They also coordinate return-to-work efforts and communicate effectively with claimants, employers, and medical providers.
Requirements
Candidates must have a high school diploma or GED, with a bachelor's degree preferred. At least three years of experience in benefits or disability case management is preferred, along with knowledge of ERISA and FMLA regulations.
Full job 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. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
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.
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
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $21-$23.50 per hour. A comprehensive benefits package is offered including but not limited to, 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 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.
Related keywords
Disability case managementERISAFMLAMedical terminologyClaims processingWorkers compensationSSDIADA accommodationsDuration guidelinesCase assessmentReturn to workMicrosoft OfficeAnalytical skillsNegotiationCustomer serviceInsurance
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.
Offices: 60 Fenchurch Street, London, England EC3M 4AD, GB · 5-6 Esplande Charles de Gaulle, Nanterre, FR
claims managementrisk managementworkers' compensationdisabilityabsence solutionsaffinityfirst and third party fleet programshealthcare risk managementretail and consumer care servicesintegrated services
How many Customer Service & Support jobs are open in Orlando, FL right now?
There are currently 3,968 open customer service & support positions in Orlando, FL listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Customer Service & Support roles in Orlando, FL?
Companies currently hiring include Hilton Grand Vacations, Starbucks, Domino's, Marriott International Hotels, Inc., Lowe's Companies, Inc., among others. Browse the listings above to see every active employer.
Are there remote or hybrid Customer Service & Support jobs in Orlando, FL?
Yes — 326 of the 3968 open customer service & support positions offer remote or hybrid work (203 remote, 123 hybrid).
How do I apply for Customer Service & Support jobs in Orlando, FL?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.