Description
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
- 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
- Knowledge of current medical practices in healthcare management
- Excellent oral and written communication skills
- Proficient computer skills, including Microsoft Office
- Analytical and interpretive skills
- Strong organisational and multitasking skills
- Excellent interpersonal skills
- Ability to exercise judgement and critical thinking skills