Remote Disability Clinical Specialist

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

Job summary

Sedgwick, a global leader in claims administration, is seeking a Telecommuter Clinical Reviewer in Florida. You will perform standard clinical evaluations on complex medical claims, consult with providers, and ensure medical information substantiates disability and work absence.

You will collaborate with claims teams, provide medical guidance, and maintain high-quality audit performance while supporting a flexible remote work arrangement across multiple states.

Qualifications

• Bachelor's degree or equivalent preferred; professional licenses as required.
• Four (4) years of related experience in medical/psych settings or equivalent.
• Clinical CEUs to maintain licenses and designations.
• Experience in insurance or related field preferred.

Responsibilities

• Performs standard clinical reviews of referred medical claims per client requirements.
• Completes medical reviews to substantiate disability and interpret impact on job functions.
• Communicates with employees and providers by phone or written correspondence.
• Provides follow-up recommendations for ongoing medical management of claims.
• Maintains high quality audit scores.
• Acts as clinical resource to claims examiners on medical management.

Skills

Medical knowledge

Communication skills

Microsoft Office

Analytical skills

Organizational skills

Interpersonal skills

Judgment & critical thinking

Teamwork

Performance competencies

Education

Bachelor's degree or equivalent preferred

Licenses: RN/LVN/LPN/CRC/COHN CVE/LPC/LCSW

Tools

Microsoft Office

Job description

Sedgwick, a global leader in claims administration, is seeking a Telecommuter Clinical Reviewer in Florida. You will perform standard clinical evaluations on complex medical claims, consult with providers, and ensure medical information substantiates disability and work absence.

You will collaborate with claims teams, provide medical guidance, and maintain high-quality audit performance while supporting a flexible remote work arrangement across multiple states.