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Job Responsibilities:
- Perform standard clinical reviews of referred medical claims to ensure accurate and sufficient information supports the claim request.
- Complete medical reviews by applying clinical knowledge to substantiate disability and interpret the impact on job functions.
- Communicate with employees and providers to discuss clinical status, progress, and work status.
Qualifications:
- Current RN, LVN, LPN, CRC, COHN, CVE, LPC, or LCSW license required.
- Four years of related experience, including direct medical/psychological setting or insurance experience.
- Knowledge of current medical practices in areas like orthopedics, general surgery, mental health, and rehabilitation.
Work Environment:
- Fully remote role in the US with a focus on work-life balance.
- Includes ability to sit at a desk for extended periods and travel as required.
- Offers comprehensive benefits: medical, dental, vision, 401k, and PTO.
Sedgwick
Sedgwick is the world's leading risk and claims administration partner, helping clients navigate the unexpected with AI-enabled technology and expertise. With over 33,000 colleagues and 10,000 clients across 80 countries, they've been recognized as a Great Place to Work and offer a caring culture.