Remote Disability Claims Clinical Specialist

Sedgwick; Madison (WI); Remote; USD 70,000 - 110,000; Full time

Job summary

Sedgwick is seeking a clinical reviewer to perform standard evaluations on disability claims, consult with providers, and ensure medical information substantiates employee absence from work. You will support claims examiners and maintain high-quality audit scores while traveling as required.

A CRC license and four years of related medical experience are required. The role offers full-time remote work with opportunities to contribute across multiple jurisdictions, leveraging strong communication

Qualifications

• Bachelor's degree or equivalent; current CRC license required.
• Four years of related experience in a medical/psychological or physical industrial medicine setting; prior insurance experience preferred.
• CEUs required to maintain licenses and designations.

Responsibilities

• Performs standard clinical reviews of referred medical claims per client requirements.
• Completes medical review of claims and interprets impact on job functions.
• Communicates with employees/providers about clinical status and work status.
• Provides follow-up recommendations for medical management of claims.

Skills

Communication

Multitasking

Interpersonal skills

Teamwork

Judgement

Analytical skills

Microsoft Office

Education

Bachelor's degree or equivalent

CRC license

Tools

Microsoft Office

Job description

Sedgwick is seeking a clinical reviewer to perform standard evaluations on disability claims, consult with providers, and ensure medical information substantiates employee absence from work. You will support claims examiners and maintain high-quality audit scores while traveling as required.

A CRC license and four years of related medical experience are required. The role offers full-time remote work with opportunities to contribute across multiple jurisdictions, leveraging strong communication