Disability Clinical Specialist

By joining Sedgwick, you'll be part of a global organisation that helps people facing unexpected challenges.

As a Disability Clinical Specialist, your primary purpose will be to perform standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and complexity.

Responsibilities:

• Perform standard clinical reviews of referred medical claims to ensure accurate and sufficient information is received by employees and providers to support the claim request
• Complete medical reviews of all claims by reviewing medical documentation received and applying practical clinical knowledge to ensure information substantiates disability and interprets the impact the condition has on the ability to perform job functions
• Communicate clearly and professionally with employees and providers to discuss clinical status, progress, and work status
• Provide clear and appropriate follow-up recommendations for ongoing medical management of claims
• Consistently achieve quality audit scores
• Act as a clinical resource to claims examiners to provide guidance on medical management of claims

Additional Responsibilities:

• Act as a backup for key disability claims on an ad hoc basis
• Perform other duties as assigned
• Travel as required

Qualifications:

• Bachelor's degree or equivalent preferred
• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW Licenses required
• Four years of related experience or equivalent combination of experience and education required
• Knowledge of current medical practices in healthcare management
• Excellent oral and written communication skills
• Proficient computer skills including working knowledge of Microsoft Office
• Analytical and interpretive skills
• Strong organisational and multitasking skills
• Excellent interpersonal skills
• Ability to exercise judgement and critical thinking skills
• Ability to work in a team environment