Remote Disability Clinical Specialist

Sedgwick; Miami (FL); Remote; USD 90,000 - 115,000; Full time

Job summary

Sedgwick is seeking a qualified Clinical Reviewer with licensure in nursing or related field to perform standard clinical evaluations on disability claims. You will review medical documentation, determine the need for employee absence, and guide claim decisions with clinical rationale.

In this remote/full-time role based in Florida, you will collaborate with providers and claims examiners, maintain high-quality audit scores, and support ongoing medical management of claims while providing clear

Qualifications

• Bachelor's degree or equivalent preferred.
• 4 years of related experience in a medical/psychological setting or industrial medicine.
• Insurance or related experience is preferred.

Responsibilities

• Perform standard clinical reviews of referred medical claims to gather sufficient information.
• Review medical documentation to support disability determinations.
• Communicate with employees and providers about clinical status and work status.
• Provide follow-up recommendations for ongoing medical management.
• Maintain quality audit scores.
• Act as clinical resource to claims examiners for medical guidance.

Skills

Medical/clinical knowledge

Communication skills

Analytical skills

Organizational skills

Interpersonal skills

Judgment and critical thinking

Team player

Performance competencies

Microsoft Office proficiency

Education

Bachelor's degree or equivalent preferred

Required licenses: RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW

Tools

Microsoft Office

Job description

Sedgwick is seeking a qualified Clinical Reviewer with licensure in nursing or related field to perform standard clinical evaluations on disability claims. You will review medical documentation, determine the need for employee absence, and guide claim decisions with clinical rationale.

In this remote/full-time role based in Florida, you will collaborate with providers and claims examiners, maintain high-quality audit scores, and support ongoing medical management of claims while providing clear