Remote Disability Claims Clinical Specialist

Sedgwick; Orlando (FL); Remote; USD 65,000 - 90,000; Full time

Job summary

Sedgwick is seeking a clinical reviewer to perform standard medical claim evaluations and provide case direction based on clinical information. You will consult with providers and employees to substantiate disability and ensure decisions are well supported.

Responsibilities include reviewing documentation, communicating status, and offering follow-up recommendations, while maintaining high-quality audit scores. This role involves remote work across multiple states and occasional travel as needed.

Qualifications

• Bachelor's degree or equivalent preferred.
• Current CRC license required and kept current with CEUs.
• Experience in medical/psychological or physical industrial medicine settings.

Responsibilities

• Perform standard clinical reviews of referred medical claims per client requirements.
• Review medical documentation to substantiate disability and impact on job functions.
• Communicate with employees and providers regarding clinical status and work status.
• Provide follow-up medical management recommendations and ensure quality scores.

Skills

Clinical reviews

Medical knowledge

Communication skills

Team collaboration

Education

Bachelor's degree or equivalent

CRC License

Tools

Microsoft Office

Job description

Sedgwick is seeking a clinical reviewer to perform standard medical claim evaluations and provide case direction based on clinical information. You will consult with providers and employees to substantiate disability and ensure decisions are well supported.

Responsibilities include reviewing documentation, communicating status, and offering follow-up recommendations, while maintaining high-quality audit scores. This role involves remote work across multiple states and occasional travel as needed.