Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more

Lensa; Santa Fe (NM); Remote; USD 63,000 - 65,000; Full time

Job summary

A leading company is seeking a Remote Accommodations Clinical Specialist to perform clinical evaluations and consult on claims. Candidates must be bilingual and possess a Bachelor's degree along with relevant experience. This role offers a competitive salary and a comprehensive benefits package, promoting a caring culture and work-life balance.

Benefits

Medical, dental, and vision insurance

401k and matching

PTO

Disability and life insurance

Flexible spending or health savings account

Qualifications

• Bachelor's degree preferred, CRC or RN license required.
• Four years of related experience or equivalent required.
• Experience in return-to-work or job accommodation preferred.

Responsibilities

• Perform clinical evaluations on claims requiring review.
• Consult with providers and employees regarding case direction.
• Ensure medical information supports employee absence or return to work.

Skills

Communication

Analytical skills

Organizational skills

Interpersonal skills

Judgment

Education

Bachelor's degree from an accredited college or university

Certified Rehabilitation Counselor (CRC) or Registered Nurse (RN) license

Tools

Microsoft Office

Job description

Remote Accommodations Clinical Specialist - Bilingual French, Hindi, Bengali or more

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work

Fortune Best Workplaces in Financial Services & Insurance

We are looking for Remote candidates who are bilingual in any of these languages:

• French
• Dutch
• Hindi
• Bengali
• German
• Mandarin
• Portuguese

Must Be Able To Work Within These Hours

• Monday - Friday 8:00 am to 4:00 pm CST
• 11:00 am to 7:00 pm CST
• 5:00 pm to 1:00 am CST
• 11:00 pm to 7:00 am CST
• 1:00 am to 9:00 am CST

Candidates must live within the United States.

PRIMARY PURPOSE

Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and employees by providing case direction and ensures medical information substantiates the need for employee absence from work or to negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration and accommodation guidelines.

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• Consults on and evaluates complex claims to determine objective, quantifiable, medically supported work restrictions/accommodations.
• Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers, documenting decision rationale.
• Completes medical reviews of all claims by assessing medical documentation and applying clinical knowledge to substantiate disability and interpret the impact on job functions.
• Communicates clearly and professionally with employees and providers, discussing clinical status, progress, and work status via phone or writing.
• Provides clear follow-up recommendations for ongoing medical management of claims, ensuring appropriate recommendations are made.
• Consistently achieves high-quality audit scores.
• Acts as a clinical resource to claims examiners, offering guidance on medical management of claims, including comprehension of medical terminology and substantiating claim decisions.

ADDITIONAL FUNCTIONS And RESPONSIBILITIES

• Acts as a backup for key disability claims on an ad hoc basis.
• Performs other duties as assigned.
• Travels as required.

Qualifications

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse (RN) 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.

Experience

Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

Skills & Knowledge

• Good working knowledge of return-to work or job accommodation procedures
• Good technical knowledge of claims management procedures
• Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation)
• Excellent oral and written communication, including presentation skills
• Proficient computer skills including working knowledge of Microsoft Office
• Analytical and interpretive skills
• Strong organizational and multitasking skills
• Excellent interpersonal skills
• Ability to exercise judgement and critical thinking skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,000 - $65,000 annual salary. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com