Sedgwick · 7 hours ago
Disability Representative
Indianapolis, IN
Full-time
Hybrid
Entry Level
$21.82/hr - $21.82/hr
2+ years expSedgwick is a leading claims management services company dedicated to supporting employees and customers facing unexpected challenges. The Disability Representative role involves providing disability case management and making routine claim determinations based on medical documentation and applicable disability plan interpretation.
BankingInsuranceRisk Management
Responsibilities
Makes claim determinations, based on the information received, to approve routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan
Reviews and analyzes routine medical information (i.e. attending physical statements, office notes, off work notes, etc.) or consults with a nurse 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) regularly
Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system
Communicates with the claimants’ providers to set expectations regarding return to work
Medically manages routine disability claims ensuring compliance with duration control guidelines and plan provisions
Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system
Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims
Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities
Negotiates return to work with or without job accommodations via the claimant’s physician and employer
Refers cases as appropriate to team lead and clinical case management to assist with claim determination
Meets the organization’s quality program(s) minimum requirements
Maintains professional client relationships and provides excellent customer service
Performs other duties as assigned
Qualification
Required
High school diploma or GED required
Two (2) years of related experience or equivalent combination of education and experience required
One (1) year of office or customer service experience required
Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
Knowledge of state and federal FMLA regulations
Working knowledge of medical terminology and duration management
Excellent oral and written communication, including presentation skills
Proficient computer skills including working knowledge of Microsoft Office
Analytical, interpretive, and critical thinking skills
Strong organizational and multitasking skills
Ability to work in a team environment
Ability to meet or exceed performance competencies as required by program
Effective decision-making and negotiation skills
Ability to exercise judgement with limited supervision
Preferred
State certification or licensing in statutory leaves is preferred or may be required based on state regulations
One (1) year of benefits or claims management experience preferred
Benefits
Medical
Dental
Vision
401k and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Company
Sedgwick
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersLa Caisse
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chairman & Chief Executive Officer
Kalani Reelitz
Global Chief Financial Officer
Recent News
Morningstar.com
2025-11-10
2025-09-04
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