Remote Disability Clinical Specialist

Financialjobbank; Detroit (MI); Remote; USD 75,000 - 105,000; Full time

Job summary

Sedgwick is seeking a Disability Clinical Specialist to perform clinical evaluations on complex claims requiring review and medical substantiation. The role involves communicating with providers and employees, delivering case direction, and ensuring medical information supports disability determinations.

The position emphasizes quality audits, medical management guidance, and teamwork, with travel as required and a strong emphasis on accuracy and professional standards.

Qualifications

• Bachelor's degree or equivalent preferred.
• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW licensure required.
• Four (4) years of related experience in a medical/psychological setting or with insurance.
• Excellent oral and written communication and interpersonal skills.

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 received and applying practical clinical knowledge to ensure information substantiates disability and to interpret the impact the condition has on the ability to perform job functions.
• Communicates clearly and professionally, on the phone and/or in writing with employee and/or providers to discuss employee's clinical status, progress, and work status.
• Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
• Consistently achieves appropriate quality audit scores.
• Acts as clinical resource to claims examiners to provide guidance on the medical management of claims including comprehension of medical terminology and substantiating claim decisions.

Skills

Medical knowledge

Communication skills

Team player

Analytical skills

Education

Bachelor's degree

Licensure (RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW)

Tools

Microsoft Office

Job description

Sedgwick is seeking a Disability Clinical Specialist to perform clinical evaluations on complex claims requiring review and medical substantiation. The role involves communicating with providers and employees, delivering case direction, and ensuring medical information supports disability determinations.

The position emphasizes quality audits, medical management guidance, and teamwork, with travel as required and a strong emphasis on accuracy and professional standards.