[Hiring] Disability Clinical Specialist @Sedgwick

Role Description

Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and employees by providing case direction and ensures medical information substantiates the need for employee absence from work.

• Performs standard clinical reviews of referred medical claims based on client requirements.
• Completes medical review of all claims by reviewing medical documentation and applying practical clinical knowledge.
• Communicates clearly and professionally with employees and/or providers regarding clinical status, progress, and work status.
• Provides clear and appropriate follow-up recommendations for ongoing medical management of claims.
• Consistently achieves appropriate quality audit scores.
• Acts as clinical resource to claims examiners for guidance on medical management of claims.

Qualifications

• 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 acquisition of necessary CEUs.
• Four (4) years of related experience or equivalent combination of experience and education required.
• Experience in a direct medical/psychological setting or physical industrial medicine.

Requirements

• Knowledge of current medical practices in health care management in various areas.
• Excellent oral and written communication skills, including presentation skills.
• Proficient computer skills including working knowledge of Microsoft Office.
• Analytical and interpretive skills.
• Strong organizational and multitasking skills.
• Excellent interpersonal skills.
• Ability to exercise judgement and critical thinking skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Benefits

• Comprehensive benefits package including medical, dental, and vision.
• 401k and matching.
• PTO, disability and life insurance.
• Employee assistance program.
• Flexible spending or health savings account.
• Other additional voluntary benefits.