Disability Clinical Specialist

This is a fully remote position, open to applicants in Alabama, +3 more states.

📋 Description

• Conduct standard clinical evaluations and assessments of referred disability medical claims.

• Examine medical documentation and utilize clinical expertise to validate disability and evaluate its effect on job responsibilities.

• Record the rationale for decisions and ensure that claim information is accurate and comprehensive.

• Engage with employees and providers regarding clinical status, progress, and work capabilities.

• Offer follow-up suggestions for the ongoing medical management of claims.

• Achieve satisfactory quality audit scores.

• Serve as a clinical resource for claims examiners regarding medical management, terminology, and claim determinations.

• Provide ad hoc support for key disability claims.

• Carry out other assigned duties and travel as needed.

⛳️ Requirements

• Bachelor’s degree or equivalent is preferred.

• Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW license(s) are mandatory.

• Current licensing, registration, and/or professional designations as required by the jurisdiction.

• Maintain clinical proficiency through the necessary CEUs to uphold licenses and designations.

• Four (4) years of relevant experience or an equivalent combination of education and experience is required.

• Experience in a direct medical/psychological setting or physical industrial medicine is preferred.

• Prior experience in insurance or a related field.

• Familiarity with current medical practices in healthcare management, including orthopedics, general medicine, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation.

• Exceptional oral and written communication skills, including presentation abilities.

• Proficient in computer skills, particularly with Microsoft Office.

• Strong analytical and interpretative abilities.

• Excellent organizational and multitasking capabilities.

• Outstanding interpersonal skills.

• Capacity to exercise sound judgment and critical thinking.

• Ability to collaborate effectively within a team environment.

• Capability to meet or surpass Performance Competencies.

• Ability to manage work-related stress, multiple priorities, and deadlines.

• Ability to remain seated at a desk for extended periods while operating a computer and phone system.

• Travel as necessary.

🏝️ Benefits

• Work-life balance.

• Supportive culture.

• Reasonable accommodations when applicable and appropriate.

• Equal opportunity workplace.

• Drug-free workplace.