Remote Clinical Claims Reviewer

Sedgwick; Atlanta (GA); Remote; USD 65,000 - 90,000; Full time

Job summary

Sedgwick is seeking a clinician to perform standard clinical reviews of medical claims and guide disability determinations. The role requires a CRC license and a strong background in medical decision-making, with remote work options across TX, FL, GA, WI, IA.

You will discuss clinical status with providers and employees, ensuring accurate information supports claims decisions. Ideal candidates have a Bachelor’s degree or equivalent and at least four years’ relevant experience, plus proficiency

Qualifications

• Bachelor's degree or equivalent preferred; CRC license required.
• Four years of related experience in medical/psychological or industrial medicine settings.
• Current license/registrations as required by the jurisdiction.
• Insurance/claims experience is preferred.
• Proficient with medical documentation and interpretation.

Responsibilities

• Performs standard clinical reviews of referred medical claims to ensure complete information.
• Completes medical review and applies clinical knowledge to substantiate disability.
• Communicates with employees/providers about clinical status and work impact.
• Provides follow-up recommendations for ongoing medical management of claims.
• Maintains high-quality audit scores and compliance.
• Acts as clinical resource to claims examiners on medical management.

Skills

Oral and written communication

Analytical thinking

Organizational skills

Interpersonal skills

Teamwork

Critical thinking

Judgement

Education

Bachelor's degree or equivalent

CRC License

Tools

Microsoft Office

Job description

Sedgwick is seeking a clinician to perform standard clinical reviews of medical claims and guide disability determinations. The role requires a CRC license and a strong background in medical decision-making, with remote work options across TX, FL, GA, WI, IA.

You will discuss clinical status with providers and employees, ensuring accurate information supports claims decisions. Ideal candidates have a Bachelor’s degree or equivalent and at least four years’ relevant experience, plus proficiency