Accommodation Clinical Specialist

About the role

Sedgwick is hiring an Accommodation Clinical Specialist, a remote position in Texas. The specialist performs standard clinical evaluations on claims that need additional review because of the medical condition, client requirements or complexity, and consults with providers and employees to make sure medical evidence supports the need for employee absence from work.

Key responsibilities

• Review referred medical claims according to client requirements so that employees and providers receive accurate, sufficient information to support the claim request and the decision rationale is documented.
• Review medical documentation and apply clinical knowledge to confirm that information substantiates disability and to interpret the impact of the condition on the ability to perform job functions.
• Communicate clearly and professionally with employees and providers by phone and in writing about clinical status, progress and work status.
• Provide clear follow-up recommendations for ongoing medical management of claims.
• Achieve appropriate quality audit scores and act as a clinical resource to claims examiners, including explaining medical terminology and substantiating claim decisions.
• Act as backup for key disability claims on an ad hoc basis, travel as required, and perform other duties as assigned.

Required profile

• Bachelor's degree or equivalent preferred; current CRC license required, plus current license, registration and/or professional designations required in the jurisdiction.
• Clinical expertise kept current through continuing education units to maintain licenses and designations.
• Four years of related experience, or an equivalent combination of experience and education, including a direct medical or psychological setting, physical industrial medicine, and previous insurance or related experience.
• Knowledge of current medical practices across areas such as orthopedics, general medicine, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation.

Required skills

• Excellent oral and written communication and presentation skills.
• Proficiency with computers, including Microsoft Office.
• Analytical, interpretive, organizational and multitasking skills.
• Teamwork, judgement, critical thinking and the ability to meet deadlines.