Sr. Disability Representative

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

Our teams connect We collaborate onsite and have a hybrid work arrangement. All candidates must live near this Center of Excellence:  

Dubuque, IA   : 4141 Westmark Drive, Dubuque, IA 52002 

Dublin, OH : 5500 Glendon Court Dublin OH 43016 

PRIMARY PURPOSE : To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors.

ESSENTIAL FUNCTIONS and 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,