
Disability Claims Clinical Specialist
Há 3 dias
The Disability Claims Clinical Specialist serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term disability claims.
You will be responsible for evaluating restrictions, limitations, and duration impacting functional capacity based on medical data, to assist in determining claim liability. You will collaborate with treating providers to ensure individuals receive appropriate care and optimize treatment outcomes while prioritizing customer satisfaction.
You will also review long and short-term disability claims to assess the impact of claimants' medical conditions on their function as well as the impact of their medical treatment in achieving improved functional outcomes.
- Well-versed with a strong clinical background in understanding and applying rationale of how injury or illness may impact the claimant's function.
- Excellent verbal and written communication skills, able to gather and report information accurately, ask relevant questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation in treatment goals.
- Able to work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work.
- Experienced in resolving customer issues to enhance the customer experience.
You will:
- Assess claimant subjective reports and objective medical evidence to determine the impact of medical conditions on function. Clarify medical information, interpret medical reports, and evaluate restrictions and limitations to assess current and ongoing level of impairment. Apply current medical knowledge regarding diagnosis, treatment, prognosis, and impairment. Participate proactively through early assessment of medical issues, work capacity, and RTW opportunities.
- Conduct analysis of claimant's current treatment plan and collaborate with healthcare providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move claimants toward appropriate care.
- Serve as a technical resource on the medical aspect of the claim. Identify opportunities to educate claim staff and peers on medical aspects of disability.
- Provide ongoing training and mentoring to claim staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.
You have:
- A valid RN license from an accredited school of nursing.
- Proficiency in multiple computer systems required.
- CCM preferred.
- Minimum of 5 years of clinical nursing experience, with at least 2 of those years within an acute care setting.
- Disability experience strongly preferred.
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