CRC-Licensed Clinical Disability Claims Specialist

Sedgwick; Texas; On-site; USD 75,000 - 95,000; Full time

Job summary

Sedgwick is seeking a qualified professional to perform standard clinical reviews of medical claims requiring detailed evaluation. You will consult with providers and employees to ensure medical information supports absence decisions and disability considerations.

Ideal candidates bring a Bachelor's degree, a current CRC license, and 4+ years of related experience in medical settings or insurance. Strong communication and analytical skills are essential for success in this role.

Qualifications

• Bachelor's degree or equivalent preferred. Current CRC License required.
• Four (4) years of related experience or equivalent combination of experience and education required.
• Clinical expertise must be kept current by acquisition of CEUs to maintain licenses and designations.

Responsibilities

• Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers to support the claim request and documents decision rationale.
• Completes medical review of all claims by reviewing medical documentation received and applying practical clinical knowledge to ensure information substantiates disability and to interpret the impact the condition has on the ability to perform job functions.
• Communicates clearly and professionally, on the phone and/or in writing with employee and/or providers to discuss employee's clinical status, progress, and work status.
• Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
• Acts as clinical resource to claims examiners to provide guidance on the medical management of claims including comprehension of medical terminology and substantiating claim decisions.

Skills

Medical terminology

Communication skills

Microsoft Office

Analytical skills

Team orientation

Education

Bachelor's degree

CRC License

Job description

Sedgwick is seeking a qualified professional to perform standard clinical reviews of medical claims requiring detailed evaluation. You will consult with providers and employees to ensure medical information supports absence decisions and disability considerations.

Ideal candidates bring a Bachelor's degree, a current CRC license, and 4+ years of related experience in medical settings or insurance. Strong communication and analytical skills are essential for success in this role.