Disability Representative

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.

Disability Representative.

Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near our dynamic Center of Excellence 📍
Irving, TX. 2201 W. Royal Lane Suite 125 Irving, Tx 75063
.

• A stable, consistent work environment
  —both in‑office and virtual.
• A comprehensive training program to help you support employees and customers from some of the world’s most respected brands.
• A dedicated mentor and manager to guide you every step of your career journey.
• Career development and promotional opportunities as you take on new responsibilities.
• A diverse, all‑inclusive benefits package designed to support your mental, physical, financial, and professional well‑being.

Your next big opportunity starts here—are you ready to join us?

Provides disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation. Includes determining benefits due, making timely payments/approvals and adjustments, medically managing disability claims, coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors.

• Makes claim determinations to approve routine disability claims or recommends denial based on the disability plan.
• Reviews and analyzes routine medical information (e.g., attending physical statements, office notes, off work notes) or consults with a nurse to determine if the claimant is disabled as defined by the plan.
• Utilizes the appropriate clinical resources in case assessment (e.g., 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.

High school diploma or GED required. State certification or licensing in statutory leaves is preferred or may be required based on state regulations.

Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of office or customer service experience required. One (1) year of benefits or claims management experience…