Remote Disability Claims Clinician

Sedgwick; Dallas (TX); Remote; USD 85,000 - 110,000; Full time

Job summary

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on complex claims, consulting with providers and employees to ensure medical substantiation for absence from work. The role requires strong communication and clinical expertise across multiple medical areas and active involvement in ongoing medical management of claims.

The position emphasizes quality, teamwork, and the ability to interpret medical information to support claim decisions, with

Qualifications

• Bachelor's degree or equivalent preferred.
• Four (4) years of related experience or equivalent combination of experience and education.
• 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.

Responsibilities

• Performs standard clinical reviews of referred medical claims based on client requirements to ensure information supports the claim decision.
• Completes medical reviews by examining documentation and applying clinical knowledge to substantiate disability and work ability.
• Communicates with employees and providers to discuss clinical status and work status.
• Provides follow-up recommendations for medical management of claims and ensures appropriate recommendations are made.

Skills

Excellent communication

Interpersonal skills

Organizational skills

Analytical thinking

Critical thinking

Team collaboration

Education

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

Bachelor's degree or equivalent preferred

Tools

Microsoft Office

Job description

Sedgwick is seeking a Disability Clinical Specialist to perform standard clinical evaluations on complex claims, consulting with providers and employees to ensure medical substantiation for absence from work. The role requires strong communication and clinical expertise across multiple medical areas and active involvement in ongoing medical management of claims.

The position emphasizes quality, teamwork, and the ability to interpret medical information to support claim decisions, with