Senior Disability Representative - Bilingual French

About the role

Sedgwick is hiring a bilingual French-speaking Senior Disability Representative in Dubuque. The role provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan, including determining benefits due and making timely payments, approvals and adjustments.

Key responsibilities

• Makes independent claim determinations to approve complex disability claims or recommends denial to the team lead
• Reviews and analyzes complex medical information such as attending physician statements, office notes and operative reports
• Manages complex claims including comorbidities, concurrent plans and complex ADA accommodations
• Determines benefits due and processes payments and adjustments for workers' compensation, SSDI and other disability offsets
• Communicates with claimants and their providers on documentation, timelines, payment information, claims status and return-to-work expectations
• Coordinates investigations, reviews contested claims and refers them to outside vendors, physician advisors, surveillance, IME or functional capability evaluations as needed
• Negotiates return to work with or without job accommodations through the claimant's physician and employer
• Meets quality program requirements and performs other duties as assigned

Required profile

• High school diploma or GED required; bachelor's degree preferred
• Preferred: state certification or licensing in statutory leaves, depending on state regulations
• Preferred: three years of benefits or disability case/claims management experience
• Bilingual French-speaking

Required skills

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management, and Social Security application procedures
• Knowledge of state and federal FMLA regulations
• Working knowledge of medical terminology and duration management
• Proficiency with Microsoft Office
• Analytical, interpretive and critical thinking, strong communication and negotiation skills, and ability to work independently and in a team