Clinical Disability Claims Reviewer

Sedgwick; Georgia; In loco; USD 65.000 - 90.000; Tempo pieno

Descrizione del lavoro

Sedgwick, a global leader in claims management, seeks an Accommodation Clinical Specialist to perform standard clinical evaluations on claims needing additional review and to consult with providers and employees to substantiate the need for employee absence from work.

Responsibilities include reviewing medical documentation, interpreting the impact on job functions, and delivering clear follow-up recommendations.

Competenze

• Bachelor's degree or equivalent preferred; CRC license required.
• Four years of related experience in medical/psychological settings or equivalent.
• Insurance or related experience is preferred.

Mansioni

• Performs standard clinical reviews of referred medical claims to ensure adequate information supports the request.
• Completes medical review by evaluating documentation and impact on disability and job functions.
• Communicates with employees and providers to discuss clinical status and work status.
• Provides follow-up recommendations for medical management and ensures decisions are well-supported.
• Maintains high quality audit scores and serves as a clinical resource to claims examiners.
• Acts as backup for key disability claims and travels as required.

Conoscenze

Medical knowledge

Communication skills

Microsoft Office

Analytical skills

Organization

Interpersonal skills

Judgement & critical thinking

Teamwork

Performance competencies

Formazione

Bachelor's degree

CRC license

Licensure CEUs

Descrizione del lavoro

Sedgwick, a global leader in claims management, seeks an Accommodation Clinical Specialist to perform standard clinical evaluations on claims needing additional review and to consult with providers and employees to substantiate the need for employee absence from work.

Responsibilities include reviewing medical documentation, interpreting the impact on job functions, and delivering clear follow-up recommendations.