Disability Specialist

About the role

Sedgwick is hiring a Disability Specialist in its West Hills, California center. The specialist provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan, including determining benefits due and making timely payments or approvals. The role also covers medically managing claims, coordinating investigations, negotiating return to work and referring claims to outside vendors.

Key responsibilities

• Make claim determinations to approve routine disability claims or recommend denial to the team lead
• Review medical information such as attending physician statements and office notes, or consult a nurse, to determine if the claimant is disabled under the plan
• Determine benefits due and make timely payments and adjustments for workers' compensation, SSDI and other disability offsets
• Inform claimants of required documentation, time frames, payment information and claims status
• Communicate with claimants' providers on return to work expectations and negotiate return to work with or without accommodations
• Coordinate investigations and thoroughly review contested claims
• Refer claims to outside vendors, physician advisors, surveillance, independent medical evaluations and other disability activities
• Meet quality program requirements and maintain professional client relationships

Required profile

• High school diploma or GED
• Two years of related experience, or an equivalent combination of education and experience
• One year of office or customer service experience
• One year of benefits or claims management experience preferred
• Ability to work with limited supervision and to meet performance competencies
• Reasonable accommodations considered where applicable

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 organization and multitasking, teamwork and negotiation skills

What we offer

• A stable, consistent work environment, in-office and virtual, with a flexible hybrid style
• A comprehensive training program and a dedicated mentor and manager
• Career development and promotion opportunities
• A benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, and flexible spending or health savings accounts
• Starting pay of $25.09 for this role in the stated jurisdiction