Disability Claims Clinical Specialist

Sedgwick; Town of King (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Sedgwick is seeking an Accommodation Clinical Specialist in Wisconsin to perform standard clinical reviews of medical claims requiring additional evaluation. You will consult with providers and employees, determine the necessity of disability, and guide medical management decisions, ensuring clear documentation and quality outcomes.

Ideal candidates hold a Bachelor's degree, a current CRC license, and the ability to maintain licensure through CEUs.

Qualifications

• Bachelor's degree or equivalent preferred.
• Current CRC License required.
• Current license, registration and/or professional designations as required within the jurisdiction.
• Clinical expertise must be kept current by acquisition of the necessary 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.
• Consistently achieves appropriate quality audit scores.
• 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 knowledge

Communication

MS Office

Analytical thinking

Organizational skills

Teamwork

Judgement

Critical thinking

Education

Bachelor's degree

CRC license

Job description

Sedgwick is seeking an Accommodation Clinical Specialist in Wisconsin to perform standard clinical reviews of medical claims requiring additional evaluation. You will consult with providers and employees, determine the necessity of disability, and guide medical management decisions, ensuring clear documentation and quality outcomes.

Ideal candidates hold a Bachelor's degree, a current CRC license, and the ability to maintain licensure through CEUs.