Remote Disability Clinical Specialist

Sedgwick; Austin (TX); Remote; USD 65,000 - 95,000; Full time

Job summary

Sedgwick, a leading risk and claims administrator, seeks a Telecommuter Clinical Reviewer to join our team. You will perform standard clinical reviews on disability claims, consult with providers, and ensure evidence supports absence from work.

You will communicate clearly with employees and providers to discuss medical status and work status. The role supports remote work across multiple states, requires health-related licensing and four years of experience, and emphasizes adherence to quality

Qualifications

• Bachelor's degree or equivalent preferred plus required licenses.
• Four (4) years of related experience in a medical/psychological setting or equivalent.
• Clinical expertise must be kept current with CEUs to maintain licenses and designations.

Responsibilities

• Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers to support the claim request and documents decision rationale.
• Completes medical review of all claims by reviewing medical documentation and applying clinical knowledge to substantiate disability and interpret impact on job functions.
• Communicates clearly with employees and providers to discuss clinical status, progress, and work status.
• Provides follow-up recommendations for ongoing medical management of claims; ensures recommendations are appropriate.

Skills

Communication

Analytical skills

Organizational skills

Multitasking

Interpersonal skills

Critical thinking

Teamwork

Medical knowledge

Education

Bachelor's degree or equivalent preferred

RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW licenses required

Tools

Microsoft Office

Job description

Sedgwick, a leading risk and claims administrator, seeks a Telecommuter Clinical Reviewer to join our team. You will perform standard clinical reviews on disability claims, consult with providers, and ensure evidence supports absence from work.

You will communicate clearly with employees and providers to discuss medical status and work status. The role supports remote work across multiple states, requires health-related licensing and four years of experience, and emphasizes adherence to quality