Disability Clinical Specialist
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Job Description
Disability Clinical Specialist evaluating medical documentation and substantiating disability claims for Sedgwick’s risk and claims administration business. Advising claims examiners on clinical management.
Responsibilities:
- Perform standard clinical evaluations and reviews of referred disability medical claims
- Review medical documentation and apply clinical knowledge to substantiate disability and assess impact on job functions
- Document decision rationale and ensure accurate, sufficient claim information
- Communicate with employees and providers about clinical status, progress, and work status
- Provide follow-up recommendations for ongoing medical management of claims
- Achieve appropriate quality audit scores
- Act as a clinical resource to claims examiners on medical management, terminology, and claim decisions
- Provide ad hoc backup for key disability claims
- Perform other assigned duties and travel as required
Requirements:
- Bachelor's degree or equivalent preferred
- Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW license(s) required
- Current license, registration and/or professional designations as required within the jurisdiction
- Maintain clinical expertise through required CEUs to maintain licenses and designations
- 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
- Previous insurance or related experience
- Knowledge of current medical practices in health care management, including orthopedics, general medicine, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation
- Excellent oral and written communication, 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 judgment and critical thinking skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
- Ability to handle work-related stress, multiple priorities, and deadlines
- Ability to sit at a desk for extended periods while operating a computer and phone system
- Travel as required
Benefits:
- Work-life balance
- Caring culture
- Reasonable accommodations when applicable and appropriate
- Equal opportunity workplace
- Drug-free workplace
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