Disability Clinical Specialist

Job Description:

• Perform standard clinical evaluations and reviews of disability claims requiring additional review based on medical condition, client requirements, or complexity
• Review medical documentation and apply clinical knowledge to substantiate disability and interpret impacts on job functions
• Communicate with employees and providers by phone and in writing regarding clinical status, progress, and work status
• Provide follow-up recommendations for ongoing medical management of claims
• Achieve appropriate quality audit scores
• Act as a clinical resource to claims examiners on medical terminology, medical management, and claim decisions
• Provide backup for key disability claims on an ad hoc basis
• Perform other assigned duties
• Travel as required

Requirements:

• Bachelor's degree or equivalent preferred
• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW license(s) required
• Current license, registration and/or professional designations as required within the jurisdiction
• Maintain clinical expertise through necessary CEUs to maintain licenses and designations
• Four (4) years of related experience or equivalent combination of experience and education required
• Experience in a direct medical/psychological setting or physical industrial medicine
• Previous insurance or related experience
• Knowledge of current medical practices in health care management, including orthopedics, acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation
• Excellent oral and written communication, including presentation skills
• Proficient computer skills, including working knowledge of Microsoft Office
• Analytical and interpretive skills
• Strong organizational and multitasking skills
• Excellent interpersonal skills
• Ability to exercise judgment and critical thinking skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies
• Ability to sit at a desk for extended periods while operating a computer and phone system
• Travel as required

Benefits:

• Work-life balance
• Reasonable accommodations considered
• Diversity, equity, and inclusion workplace
• Drug-free workplace