Disability Claims Clinical Specialist

Sedgwick; Wisconsin; On-site; USD 80,000 - 110,000; Full time

Job summary

Sedgwick is seeking an Accommodation Clinical Specialist to conduct standard clinical reviews of claims requiring additional medical evaluation. You will consult with providers and employees, determine disability impact on job functions, and ensure proper documentation supports decisions.

The role requires a Bachelor's degree (or equivalent), a CRC license, and at least four years of related experience in clinical or insurance settings. Occasional travel may be required.

Qualifications

• Bachelor's degree or equivalent required; CRC license required.
• Four years of related experience in a direct medical/psychological setting or physical industrial medicine and insurance experience.
• CRC license current and CEU maintenance as required by jurisdiction.

Responsibilities

• Performs standard clinical reviews of referred medical claims to ensure adequate information is received to support the claim decision.
• Completes medical reviews by evaluating documentation and determining disability impact on job functions.
• Communicates with employees and providers by phone or written correspondence regarding clinical status and work status.
• Provides follow-up recommendations for medical management and ensures recommendations are appropriate for claims.
• Acts as clinical resource to claims examiners for medical terminology and decisions.
• Backs up key disability claims and travels as needed.

Skills

Medical knowledge

Communication skills

Analytical skills

Organizational skills

Interpersonal skills

Teamwork

Critical thinking

Problem solving

Judgement

Education

Bachelor's degree or equivalent

CRC License

Professional license requirement

Tools

Microsoft Office

Job description

Sedgwick is seeking an Accommodation Clinical Specialist to conduct standard clinical reviews of claims requiring additional medical evaluation. You will consult with providers and employees, determine disability impact on job functions, and ensure proper documentation supports decisions.

The role requires a Bachelor's degree (or equivalent), a CRC license, and at least four years of related experience in clinical or insurance settings. Occasional travel may be required.