Remote Disability Clinical Specialist

Sedgwick; Orlando (FL); A distancia; USD 70.000 - 90.000; Jornada completa

Descripción de la vacante

Sedgwick, a leading provider of claims management, seeks a qualified clinical reviewer to evaluate medical claims requiring additional review. The role involves consulting with providers and employees to ensure medical information substantiates the need for absence from work and supports disability decisions.

The position requires clinical expertise across multiple medical domains, strong written and verbal communication, and the ability to work collaboratively in a fast-paced environment.

Formación

• Bachelor's degree or equivalent preferred.
• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW licenses required.
• Clinical expertise must be kept current by CEUs to maintain licenses/designetions.
• Four (4) years of related experience in medical/psychological or physical industrial medicine; insurance or related experience.
• Understanding of medical practices across orthopedics, general medicine, mental health, oncology and rehab.

Responsabilidades

• Performs standard clinical reviews of referred medical claims based on client requirements to ensure information is received to support the claim decision.
• Completes medical review of all claims by reviewing medical docs and applying clinical knowledge to support disability determinations.
• Communicates with employees and providers to discuss clinical status, progress, and work status.
• Provides follow-up recommendations for ongoing medical management of claims.
• Maintains high-quality audit scores and serves as clinical resource to claims examiners.
• Acts as backup for key disability claims when needed.
• Travels as required.

Conocimientos

Medical knowledge

Communication skills

Computer skills

Analytical skills

Organizational skills

Interpersonal skills

Critical thinking

Teamwork

Multitasking

Educación

Bachelor's degree or equivalent preferred

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

Herramientas

Microsoft Office

Descripción del empleo

Sedgwick, a leading provider of claims management, seeks a qualified clinical reviewer to evaluate medical claims requiring additional review. The role involves consulting with providers and employees to ensure medical information substantiates the need for absence from work and supports disability decisions.

The position requires clinical expertise across multiple medical domains, strong written and verbal communication, and the ability to work collaboratively in a fast-paced environment.