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.

• 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 experienced specialists.

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

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.

Six (6) years of related experience or equivalent combination of education and experience required.

• 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

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.

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.