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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
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Sr Disability Representative
Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:
Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002
Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604
PRIMARY PURPOSE
The Senior Disability Representative is responsible for overseeing complex disability claims with a high level of autonomy and expertise. This role involves interpreting medical documentation and disability plan provisions to determine benefits eligibility, process timely payments and approvals, and manage claims involving comorbidities, concurrent plans, and ADA accommodations. The position also includes coordinating investigative efforts, reviewing contested claims, facilitating return-to-work strategies, and arranging referrals to external vendors when necessary.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Independently evaluates and adjudicates complex disability claims, recommending denials to leadership when appropriate and ensuring alignment with plan guidelines.
- Conducts thorough analysis of medical documentation—including attending physician statements, clinical notes, and surgical reports—to assess disability status.
- Manages multifaceted claims involving overlapping conditions, concurrent benefit plans, and ADA-related accommodations.
- Leverages clinical resources, such as duration guidelines and internal medical consultants, to support case assessments.
- Determines benefits in accordance with plan provisions and ensures timely processing of payments and adjustments, including offsets for workers’ compensation and Social Security Disability Income (SSDI).
- Communicates clearly and professionally with claimants regarding required documentation, timelines, payment details, and claim status via phone, written correspondence, and system updates.
- Engages with healthcare providers to establish realistic return-to-work expectations.
- Oversees medical management of claims, ensuring compliance with duration control standards and plan requirements.
- Maintains consistent and transparent communication with claimants and clients throughout the claims lifecycle.
- Coordinates investigative efforts and conducts comprehensive reviews of disputed claims.
- Facilitates referrals to external vendors for independent medical evaluations, functional capacity assessments, surveillance, and other specialized services.
- Negotiates return-to-work plans, with or without accommodations, in collaboration with physicians and employers.
- Escalates cases to team leads or clinical case managers for further review when necessary.
- Cultivates strong client relationships and delivers exceptional customer service.
- Adheres to organizational quality standards and performance metrics.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned, demonstrating flexibility and adaptability in a dynamic work environment.
QUALIFICATIONS
Education & Licensing
- High school diploma or GED required.
- Bachelor’s degree from an accredited institution preferred.
- State certification or licensing in statutory leave management preferred or may be required based on jurisdictional regulations.
Experience
- Minimum of three (3) years of experience in benefits administration or disability case/claims management, or an equivalent combination of education and experience.
Skills & Knowledge
- Comprehensive understanding of ERISA regulations, disability offsets, duration guidelines, and SSDI procedures.
- Familiarity with federal and state FMLA regulations.
- Proficiency in medical terminology and duration management practices.
- Strong written and verbal communication skills, including the ability to present information effectively.
- Proficient in Microsoft Office and claims management systems.
- Demonstrated analytical, interpretive, and critical thinking abilities.
- Capacity to manage ambiguity and exercise sound judgment within established protocols.
- Exceptional organizational and multitasking capabilities.
- Collaborative mindset with the ability to thrive in a team-oriented environment.
- Proven ability to meet or exceed performance standards.
- Effective decision-making and negotiation skills.
WORK ENVIRONMENT
Mental Requirements
- Ability to think conceptually and exercise sound judgment.
- Strong problem-solving and analytical skills.
- Capacity to manage multiple priorities and meet deadlines in a fast-paced environment.
Physical Requirements
- Ability to remain seated for extended periods while operating a computer and telephone system.
- Occasional travel may be required.
Auditory/Visual Requirements
- Adequate hearing, vision, and verbal communication skills to perform essential functions.
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 $22.00 - $24.00 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.
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
amanda.strothman@sedgwick.com
True
False
True
Job Details
Categories
Insurance
Technical
Location
Dubuque, IA
Job Type
Employee
Full/Part
Full Time
Company ID
8326
Job REQ #
R66345
# Positions
1
Start Date
20251105
End Date
20251210
Featured Job
TH Ad
TH Comments
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"PlainText": " Job Title: Sr Disability Representative\r\n\r\n Company Name: Sedgwick\r\n\r\n Job Type: employee\r\n Job Status: full_time\r\n\r\n 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.\r\n\r\n Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies\r\n\r\n Certified as a Great Place to Work\u00ae\r\n\r\n Fortune Best Workplaces in Financial Services & Insurance\r\n\r\n Sr Disability Representative\r\n\r\n Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:\r\n\r\n Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002\r\n\r\n Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604\r\n\r\n PRIMARY PURPOSE\r\n\r\n The Senior Disability Representative is responsible for overseeing complex disability claims with a high level of autonomy and expertise. This role involves interpreting medical documentation and disability plan provisions to determine benefits eligibility, process timely payments and approvals, and manage claims involving comorbidities, concurrent plans, and ADA accommodations. The position also includes coordinating investigative efforts, reviewing contested claims, facilitating return-to-work strategies, and arranging referrals to external vendors when necessary.\r\n\r\n ESSENTIAL FUNCTIONS and RESPONSIBILITIES\r\n\r\n * Independently evaluates and adjudicates complex disability claims, recommending denials to leadership when appropriate and ensuring alignment with plan guidelines.\r\n * Conducts thorough analysis of medical documentation-including attending physician statements, clinical notes, and surgical reports-to assess disability status.\r\n * Manages multifaceted claims involving overlapping conditions, concurrent benefit plans, and ADA-related accommodations.\r\n * Leverages clinical resources, such as duration guidelines and internal medical consultants, to support case assessments.\r\n * Determines benefits in accordance with plan provisions and ensures timely processing of payments and adjustments, including offsets for workers' compensation and Social Security Disability Income (SSDI).\r\n * Communicates clearly and professionally with claimants regarding required documentation, timelines, payment details, and claim status via phone, written correspondence, and system updates.\r\n * Engages with healthcare providers to establish realistic return-to-work expectations.\r\n * Oversees medical management of claims, ensuring compliance with duration control standards and plan requirements.\r\n * Maintains consistent and transparent communication with claimants and clients throughout the claims lifecycle.\r\n * Coordinates investigative efforts and conducts comprehensive reviews of disputed claims.\r\n * Facilitates referrals to external vendors for independent medical evaluations, functional capacity assessments, surveillance, and other specialized services.\r\n * Negotiates return-to-work plans, with or without accommodations, in collaboration with physicians and employers.\r\n * Escalates cases to team leads or clinical case managers for further review when necessary.\r\n * Cultivates strong client relationships and delivers exceptional customer service.\r\n * Adheres to organizational quality standards and performance metrics.\r\n\r\n ADDITIONAL FUNCTIONS and RESPONSIBILITIES\r\n\r\n * Performs other duties as assigned, demonstrating flexibility and adaptability in a dynamic work environment.\r\n\r\n QUALIFICATIONS\r\n\r\n Education & Licensing\r\n * High school diploma or GED required.\r\n * Bachelor's degree from an accredited institution preferred.\r\n * State certification or licensing in statutory leave management preferred or may be required based on jurisdictional regulations.\r\n\r\n Experience\r\n * Minimum of three (3) years of experience in benefits administration or disability case\/claims management, or an equivalent combination of education and experience.\r\n\r\n Skills & Knowledge\r\n * Comprehensive understanding of ERISA regulations, disability offsets, duration guidelines, and SSDI procedures.\r\n * Familiarity with federal and state FMLA regulations.\r\n * Proficiency in medical terminology and duration management practices.\r\n * Strong written and verbal communication skills, including the ability to present information effectively.\r\n * Proficient in Microsoft Office and claims management systems.\r\n * Demonstrated analytical, interpretive, and critical thinking abilities.\r\n * Capacity to manage ambiguity and exercise sound judgment within established protocols.\r\n * Exceptional organizational and multitasking capabilities.\r\n * Collaborative mindset with the ability to thrive in a team-oriented environment.\r\n * Proven ability to meet or exceed performance standards.\r\n * Effective decision-making and negotiation skills.\r\n\r\n WORK ENVIRONMENT\r\n\r\n Mental Requirements\r\n * Ability to think conceptually and exercise sound judgment.\r\n * Strong problem-solving and analytical skills.\r\n * Capacity to manage multiple priorities and meet deadlines in a fast-paced environment.\r\n\r\n Physical Requirements\r\n * Ability to remain seated for extended periods while operating a computer and telephone system.\r\n * Occasional travel may be required.\r\n\r\n Auditory\/Visual Requirements\r\n * Adequate hearing, vision, and verbal communication skills to perform essential functions.\r\n\r\n 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.\r\n\r\n 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 $22.00 - $24.00 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.\r\n\r\n Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.\r\n\r\n 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.\r\n\r\n About the Company\r\n\r\n 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\r\n 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.",
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