Disability Claims Clinical Specialist

Sedgwick; Iowa; On-site; USD 70,000 - 90,000; Full time

Job summary

Sedgwick is seeking an Accommodation Clinical Specialist to perform standard clinical evaluations on claims needing additional review. You will consult with providers, interpret medical information, and determine the need for employee absence from work.

The role emphasizes communication with employees and providers and maintaining high quality audit scores. Responsibilities include clinical reviews, medical documentation assessment, and providing guidance to claims examiners.

Qualifications

• Bachelor's degree or equivalent; CRC license required with CEUs.
• Four years of related experience in medical/psych/insurance settings.
• Strong communication, analytical, and teamwork abilities.

Responsibilities

• Performs standard clinical reviews of referred medical claims per client requirements.
• Reviews medical documentation and applies clinical knowledge to support disability determinations.
• Communicates with employees and providers by phone or written to discuss status.
• Provides follow-up recommendations for ongoing medical management of claims.
• Acts as clinical resource to claims examiners on medical management of claims.
• Backups for key disability claims and travels as required.

Skills

Communication skills

Analytical skills

Organizational skills

Interpersonal skills

Teamwork

Judgement & critical thinking

Problem solving

Education

Bachelor's degree or equivalent

CRC license

Experience in medical/psychic/insurance setting

Tools

Microsoft Office

Job description

Sedgwick is seeking an Accommodation Clinical Specialist to perform standard clinical evaluations on claims needing additional review. You will consult with providers, interpret medical information, and determine the need for employee absence from work.

The role emphasizes communication with employees and providers and maintaining high quality audit scores. Responsibilities include clinical reviews, medical documentation assessment, and providing guidance to claims examiners.