Remote Disability Claims Clinical Specialist

Sedgwick; Tampa (FL); Remoto; USD 70.000 - 100.000; Tempo pieno

Descrizione del lavoro

Sedgwick is seeking a Telecommuter Clinical Claims Reviewer to perform standard clinical evaluations on claims requiring complex medical review. You will consult with providers, ensure medical information substantiates the need for employee absence, and support claims decisions with clinical rationale.

Role involves remote work across multiple states; strong communication, analytical, and teamwork skills are essential. BA/BS and CRC license required, with CEUs to maintain licensure.

Competenze

• Bachelor's degree or equivalent preferred; CRC license required.
• Current license/registrations as required within the jurisdiction; CEUs to maintain licenses.
• Four years of related experience in medical/psychological setting or physical industrial medicine and insurance experience.

Mansioni

• Performs standard clinical reviews of referred medical claims per client requirements to ensure sufficient information supports the request.
• Completes medical review by evaluating documentation to substantiate disability and assess impact on job functions.
• Communicates with employees/providers to discuss clinical status, progress, and work status.
• Provides follow-up recommendations for ongoing medical management of claims and ensures appropriate recommendations are made.
• Maintains high quality audit scores.
• Acts as a clinical resource to claims examiners on medical management and terminology.

Conoscenze

Medical knowledge

Excellent communication

Microsoft Office

Analytical skills

Organizational skills

Interpersonal skills

Judgment and critical thinking

Teamwork

Performance competencies

Formazione

Bachelor's degree

CRC License

Strumenti

Microsoft Office

Descrizione del lavoro

Sedgwick is seeking a Telecommuter Clinical Claims Reviewer to perform standard clinical evaluations on claims requiring complex medical review. You will consult with providers, ensure medical information substantiates the need for employee absence, and support claims decisions with clinical rationale.

Role involves remote work across multiple states; strong communication, analytical, and teamwork skills are essential. BA/BS and CRC license required, with CEUs to maintain licensure.