Sedgwick
Overview
Sedgwick est l'un des principaux fournisseurs mondiaux de gestion de risques, de santé, de prévoyance et de solutions d’assurance intégrées. Dans le cadre de sa croissance et de son développement international, Sedgwick s’implante en France à travers ses activités d’expertise d’assurance. Afin d’être au plus proche et de répondre aux besoins de ses clients, Sedgwick propose des solutions et adapte son offre en fonction des évolutions actuelles et futures du marché. Nos 27 000 collègues présents dans 65 pays avancent dans un but commun : délivrer l’excellence pour nos clients et nos partenaires. En France, Sedgwick compte parmi les leaders du marché de la gestion des risques auprès de ses clients assureurs. Nos 800 collègues sont répartis sur 30 sites, afin d’assurer une présence nationale. Nous laissons part à la créativité, à l’innovation et donnons l’opportunité à nos collègues de développer leurs compétences dans un environnement propice à l’épanouissement personnel. Nos valeurs fondamentales — Empathie, Responsabilité, Collaboration, Croissance et Intégration — guident notre façon de travailler au quotidien et sont la force motrice de notre succès collectif. Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims. Makes timely, appropriate contact with employee and/or providers to discuss employee’s clinical status, progress and work status. Achieves appropriate quality audit scores on a consistent basis. Acts as clinical resource to colleagues within the program. Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Ability to meet or exceed Performance Competencies Ability to work in a team environment Excellent interpersonal skills Strong organizational skill Analytical and interpretive skills PC literate, including Microsoft Office products Oral and written communication, including presentation skills Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation) WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical:
Computer keyboarding, travel as required Auditory/Visual:
Hearing, vision and talking NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Qualifications Education & Licensing Bachelor's degree or equivalent preferred. RN or LPN required. Current license, registration and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations. Experience Four (4) years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Si ce poste vous intéresse mais que votre expérience ne correspond pas parfaitement à toutes les qualifications de sa description, envisagez de postuler quand même ! Sedgwick construit un lieu de travail diversifié, équitable et inclusif et considère que chaque personne possède une combinaison unique de compétences, de connaissances et d’expérience. Vous êtes peut-être le bon candidat pour ce poste ou pour d’autres.
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Sedgwick est l'un des principaux fournisseurs mondiaux de gestion de risques, de santé, de prévoyance et de solutions d’assurance intégrées. Dans le cadre de sa croissance et de son développement international, Sedgwick s’implante en France à travers ses activités d’expertise d’assurance. Afin d’être au plus proche et de répondre aux besoins de ses clients, Sedgwick propose des solutions et adapte son offre en fonction des évolutions actuelles et futures du marché. Nos 27 000 collègues présents dans 65 pays avancent dans un but commun : délivrer l’excellence pour nos clients et nos partenaires. En France, Sedgwick compte parmi les leaders du marché de la gestion des risques auprès de ses clients assureurs. Nos 800 collègues sont répartis sur 30 sites, afin d’assurer une présence nationale. Nous laissons part à la créativité, à l’innovation et donnons l’opportunité à nos collègues de développer leurs compétences dans un environnement propice à l’épanouissement personnel. Nos valeurs fondamentales — Empathie, Responsabilité, Collaboration, Croissance et Intégration — guident notre façon de travailler au quotidien et sont la force motrice de notre succès collectif. Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims. Makes timely, appropriate contact with employee and/or providers to discuss employee’s clinical status, progress and work status. Achieves appropriate quality audit scores on a consistent basis. Acts as clinical resource to colleagues within the program. Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Ability to meet or exceed Performance Competencies Ability to work in a team environment Excellent interpersonal skills Strong organizational skill Analytical and interpretive skills PC literate, including Microsoft Office products Oral and written communication, including presentation skills Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation) WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical:
Computer keyboarding, travel as required Auditory/Visual:
Hearing, vision and talking NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Qualifications Education & Licensing Bachelor's degree or equivalent preferred. RN or LPN required. Current license, registration and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations. Experience Four (4) years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Si ce poste vous intéresse mais que votre expérience ne correspond pas parfaitement à toutes les qualifications de sa description, envisagez de postuler quand même ! Sedgwick construit un lieu de travail diversifié, équitable et inclusif et considère que chaque personne possède une combinaison unique de compétences, de connaissances et d’expérience. Vous êtes peut-être le bon candidat pour ce poste ou pour d’autres.
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