Disability Claims Clinical Specialist

Sedgwick; United States; Remote; USD 62.000 - 63.000; Vollzeit

Zusammenfassung

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on claims requiring additional review based on medical condition and client requirements. You will consult with providers and employees, ensuring medical information substantiates the need for employee absence from work.

Key duties include performing reviews, interpreting the impact of conditions on job functions, and providing recommendations for ongoing medical management. Travel may be required.

Qualifikationen

• Bachelor’s degree or equivalent preferred.
• Current RN, CRC, LPC and/or LCSW Licenses required.
• Clinical expertise must be kept current by CEUs.

Aufgaben

• Performs standard clinical reviews of referred medical claims to ensure information supports the claim request and documents rationale.
• Completes medical review by evaluating documentation to substantiate disability and impact on job functions.
• Communicates with employees/providers to discuss clinical status and work status.
• Provides follow-up recommendations for medical management of claims.
• Maintains quality audit scores and serves as clinical resource to claims examiners.
• Travel as required; acts as backup for key disability claims.

Kenntnisse

Medical review

Communication skills

Microsoft Office

Analytical skills

Organizational skills

Interpersonal skills

Critical thinking

Teamwork

Ausbildung

Bachelor’s degree

RN license

CRC license

LPC license

LCSW license

Tools

Microsoft Office

Jobbeschreibung

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on claims requiring additional review based on medical condition and client requirements. You will consult with providers and employees, ensuring medical information substantiates the need for employee absence from work.

Key duties include performing reviews, interpreting the impact of conditions on job functions, and providing recommendations for ongoing medical management. Travel may be required.