Hiring: Disability Representative Sr Company: Sedgwick Location: Southfield, MI Job Posted Time: 2026-09-10 10:17:07 Employment Type: Hybrid About the job Experience: •Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. •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 •Solid functional working knowledge of medical terminology and duration management •Excellent oral and written communication, including presentation skills Required Skills: •Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan. •Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan. •Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. •Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed. •Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals 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 complex disability claims ensuring compliance with duration control guidelines and plan provisions. Qualifications: •High School diploma or GED required. Bachelor's degree from an accredited university or college preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!