Remote Disability Claims Clinician

Sedgwick; Miami (FL); Remote; USD 70,000 - 100,000; Full time

Job summary

Sedgwick is seeking a Clinical Claims Reviewer to perform standard clinical evaluations on claims requiring additional review based on medical condition and client requirements. You will consult with providers and employees, ensuring medical information substantiates the need for employee absence from work.

The role emphasizes clear communication, collaboration with examiners, and delivering quality medical management recommendations. Travel may be required in some cases.

Qualifications

• Bachelor's degree or equivalent preferred with licensure as required in the jurisdiction.
• CRC license required and must be maintained with CEUs.
• Clinical expertise kept current by continuing education.

Responsibilities

• Performs standard clinical reviews of referred medical claims to ensure sufficient information.
• Completes medical reviews applying clinical knowledge to substantiate disability and work status.
• Communicates with employees and providers to discuss clinical status and progress.
• Provides follow-up medical management recommendations for ongoing claims.
• Maintains high quality audit scores through accurate work.
• Acts as clinical resource to claims examiners on medical management and terminology.

Skills

Medical claim review

Oral and written communication

Microsoft Office

Analytical interpretation

Organizational skills

Interpersonal skills

Judgement & critical thinking

Teamwork

Performance competencies

Education

Bachelor's degree or equivalent

Current CRC License

Tools

Microsoft Office

Job description

Sedgwick is seeking a Clinical Claims Reviewer to perform standard clinical evaluations on claims requiring additional review based on medical condition and client requirements. You will consult with providers and employees, ensuring medical information substantiates the need for employee absence from work.

The role emphasizes clear communication, collaboration with examiners, and delivering quality medical management recommendations. Travel may be required in some cases.