Remote Disability Claims Clinical Specialist

Sedgwick; Madison (WI); Remote; USD 70,000 - 100,000; Full time

Job summary

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on claims requiring additional review. The role involves consulting with providers and employees, ensuring medical information substantiates the need for employee absence from work, and guiding claims decisions.

Requires a Bachelor's degree or equivalent, active RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW licenses, and 4 years of related medical experience.

Qualifications

• Bachelor's degree or equivalent preferred.
• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW Licenses required.
• Clinical expertise must be kept current by acquisition of CEUs to maintain licenses and designations.
• Four (4) years of related experience in a direct medical/psychological setting or physical industrial medicine and insurance experience.

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 with employee and providers to discuss employee’s clinical status, progress, and work status.
• Provides clear follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
• 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

Clinical evaluation

Communication skills

Analytical skills

Organization

Team orientation

Problem solving

Education

RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW license

Bachelor's degree or equivalent

Tools

Microsoft Office

Job description

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on claims requiring additional review. The role involves consulting with providers and employees, ensuring medical information substantiates the need for employee absence from work, and guiding claims decisions.

Requires a Bachelor's degree or equivalent, active RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW licenses, and 4 years of related medical experience.