Description

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 acquitision 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.
Requisition #: R68811

6ahf9io63