Sedgwick
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Senior Disability Clinical Specialist PRIMARY PURPOSE To perform standard and complex clinical evaluations as determined by clinical screenings and patient assessments. To consult providers and employees by providing case direction. Ensures medical information corroborates the need for employee absence from work.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Performs and completes complex clinical reviews of referred medical claims to ensure accurate information is received by employees and providers
Makes regular timely, appropriate contact with employees and/or providers to discuss clinical status, progress, and work status.
Substantiates disability and provides follow-up recommendations for ongoing medical management of claims
Ensures appropriate recommendations are made on claims.
Assists with clinical training, onboarding, examiner presentations, and processes change assessments
Assists with updating clinical teamsite and training references.
Analyzes work queues and assignment workloads to ensure appropriate requirements are met
Assists with escalations
Acts as a backup for the team lead and mentors less experience specialists.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Current RN Licenses are 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 Six (6) years of related experience or equivalent combination of education and experience required.
Skills & Knowledge
Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Proven management/leadership skills
Excellent negotiating skills
Ability to create and complete comprehensive, accurate and constructive written reports
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
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.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com
#J-18808-Ljbffr
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Senior Disability Clinical Specialist PRIMARY PURPOSE To perform standard and complex clinical evaluations as determined by clinical screenings and patient assessments. To consult providers and employees by providing case direction. Ensures medical information corroborates the need for employee absence from work.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Performs and completes complex clinical reviews of referred medical claims to ensure accurate information is received by employees and providers
Makes regular timely, appropriate contact with employees and/or providers to discuss clinical status, progress, and work status.
Substantiates disability and provides follow-up recommendations for ongoing medical management of claims
Ensures appropriate recommendations are made on claims.
Assists with clinical training, onboarding, examiner presentations, and processes change assessments
Assists with updating clinical teamsite and training references.
Analyzes work queues and assignment workloads to ensure appropriate requirements are met
Assists with escalations
Acts as a backup for the team lead and mentors less experience specialists.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Current RN Licenses are 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 Six (6) years of related experience or equivalent combination of education and experience required.
Skills & Knowledge
Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Proven management/leadership skills
Excellent negotiating skills
Ability to create and complete comprehensive, accurate and constructive written reports
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
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.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com
#J-18808-Ljbffr