Sedgwick · 1 week ago
Disability Representative Senior
Cedar Rapids, IA
Full-time
Hybrid
Mid, Senior Level
3+ years expSedgwick is a leading claims management services company dedicated to supporting individuals facing unexpected challenges. The Disability Representative Senior will manage disability cases, analyze medical documentation, determine benefits, and ensure compliance with disability plans while maintaining clear communication with claimants and clients.
BankingInsuranceRisk Management
Responsibilities
Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan
Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan
Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians)
Communicates with the claimants providers to set expectations regarding return to work
Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions
Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence
Informs claimants of documentation required to process claims, required time frames, payment information and claims status either 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 claimants physician and employer
Refers cases as appropriate to team lead and clinical case management
Maintains professional client relationships
Performs other duties as assigned
Supports the organization's quality program(s)
Qualification
Required
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required
Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
Working knowledge of medical terminology and duration management
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Ability to work in a team environment
Excellent negotiation skills
Ability to meet or exceed Performance Competencies
Credit security clearance, confirmed via a background credit check, is required for this position
Preferred
Bachelor's degree from an accredited university or college preferred
Company
Sedgwick
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersLa Caisse
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chairman & Chief Executive Officer
Kalani Reelitz
Global Chief Financial Officer
Recent News
Morningstar.com
2025-11-10
2025-09-04
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