Disability Representative Sr.

Job Overview

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

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Disability Representative Sr.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES 

• Independently evaluates complex disability claims and makes approval decisions based on received documentation, or recommends denial to the team lead in alignment with the disability plan.

• Carefully reviews and interprets detailed medical records—including attending physician statements, office notes, and operative reports—to assess whether the claimant meets the plan’s definition of disability.

• Oversees multifaceted claims involving comorbid conditions, overlapping benefit plans, ADA accommodations, and cases that fall outside standard guidelines.

• Applies clinical resources such as duration guidelines and consults with in-house clinicians to support case assessments when necessary.

• Calculates benefits due under the disability plan and ensures timely processing of payments, approvals, and adjustments—including offsets for workers’ compensation, Social Security Disability Income (SSDI), and other applicable sources.

• Clearly communicates with claimants regarding required documentation, timelines, payment details, and claim status through phone calls, written correspondence, and system updates.

• Engages with healthcare providers to establish expectations for return-to-work timelines and accommodations.

• Manages complex disability claims with a focus on medical compliance, duration control, and adherence to plan provisions.

• Maintains consistent and transparent communication with claimants and clients throughout the claims process via phone, written updates, and system documentation.

• Coordinates investigative efforts to ensure thorough and appropriate claim reviews.

• Identifies when claims require external support and arranges referrals to vendors for services such as physician advisor reviews, surveillance, independent medical evaluations, and functional capability assessments.

• Facilitates return-to-work negotiations with or without accommodations, collaborating with the claimant’s physician and employer.

• Escalates cases to the team lead or clinical case management for further review when appropriate.

• Builds and maintains professional relationships with clients, delivering high-quality customer service.

• Meets or exceeds the organization’s quality standards and program requirements.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing

• High school diploma or GED is required.

• Bachelor’s degree from an accredited college or university is preferred.

• State certification or licensing in statutory leaves is preferred or may be required depending on local regulations.

Experience

• Preferred: Three (3) years of experience in benefits or disability case/claims management, or an equivalent combination of education and experience.

Skills & Knowledge

• Solid understanding of ERISA regulations, disability offsets and deductions, medical management practices, and Social Security Disability application procedures.

• Familiarity with federal and state FMLA regulations.

• Working knowledge of medical terminology and duration management.

• Strong verbal and written communication skills, including the ability to present information clearly.

• Proficiency in Microsoft Office and general computer systems.

• Analytical mindset with strong interpretive and critical thinking abilities.

• Comfortable navigating ambiguity and making informed decisions.

• Excellent organizational and multitasking capabilities.

• Collaborative team player with a commitment to performance excellence.

• Skilled in negotiation and autonomous decision-making within established procedures.

• Ability to exercise sound judgment and maintain discretion.

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

Ready to Make a Difference?

Apply today and become part of a team that’s redefining care and support in the workplace. At Sedgwick, your work matters—and so do you.

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.

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 $20.39 - $24.00 USD Hourly. 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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

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.