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Accommodation Clinical SpecialistPRIMARY PURPOSE: Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and employees by providing case direction and ensures medical information substantiates the need for employee absence from work.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers to support the claim request and documents decision rationale.
- Completes medical review of all claims by reviewing medical documentation received and applying practical clinical knowledge to ensure information substantiates disability and to interpret the impact the condition has on the ability to perform job functions.
- Communicates clearly and professionally, on the phone and/or in writing with employee and/or providers to discuss employee’s clinical status, progress, and work status.
- Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
- Consistently achieves appropriate quality audit scores.
- Acts as clinical resource to claims examiners to provide guidance on the medical management of claims including comprehension of medical terminology and substantiating claim decisions.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Acts as a backup for key disability claims on an ad hoc basis.
- Performs other duties as assigned.
- Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree or equivalent preferred. Current CRC License 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.
Experience
Four (4) years of related experience or equivalent combination of experience and education required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance or related experience.
Skills & Knowledge
- Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for 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 judgement and critical thinking skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
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: Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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.Skills Required
- Current CRC license
- Four years of related experience or equivalent combination of experience and education
- Experience in a direct medical or psychological setting, or physical industrial medicine
- Previous insurance or related experience
- Current licenses, registrations, and/or professional designations required within the applicable jurisdiction
- Bachelor's degree or equivalent
- Knowledge of medical practices across orthopedics, general medicine, surgery, mental health, obstetrics, oncology, and rehabilitation
- Excellent oral and written communication skills
- Proficient computer skills, including Microsoft Office
- Analytical, interpretive, organizational, multitasking, interpersonal, judgment, and critical-thinking skills
Sedgwick Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Sedgwick and has not been reviewed or approved by Sedgwick.
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Leave & Time Off Breadth — Generous paid time off and paid holidays are emphasized, with PTO accruals increasing with tenure. Paid parental leave and caregiver support further expand time-off coverage.
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Healthcare Strength — Medical, dental and vision coverage is complemented by telemedicine and a personal health concierge. Wellbeing supports such as diabetes and weight-management programs, fertility services, and robust mental-health access (coaching, therapy, psychiatry) broaden care.
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Parental & Family Support — Paid parental leave and caregiver support are offered alongside family-forming resources. Fertility services and adoption assistance reinforce family-oriented benefits.
Sedgwick Insights
What We Do
From our modest beginnings as a regional claims administrator, Sedgwick has grown into a leading global provider of technology-enabled risk, benefits and integrated business solutions with 31,000+ colleagues, located across 80 countries. Through innovative product development, organic business development and strategic acquisitions, Sedgwick’s offerings continue to evolve beyond claims processing to meet the current and future needs of our clients. Our approach to delivering quality service in areas such as workers’ compensation, liability, property, disability and absence management goes far beyond just managing claims—we aim to simplify the process and reduce complexity, making it easy and effective for everyone involve.
Why Work With Us
We stay tuned into what our colleagues want and need and deliver a world-class colleague experience that demonstrates how much we value their unique contributions to our business. You’ll see and feel what it’s like to work for a company that’s committed to doing the right thing – for those we serve, for our planet and for each other.
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