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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates clinical expertise in evaluating disability claims, applying medical knowledge to assess job function impacts, and providing recommendations for ongoing medical management. Proficient in communication and collaboration with employees and providers, ensuring quality audit scores and effective claims management.
Highest-signal resume keywords
Current RN LicenseClinical Evaluation SkillsMedical Documentation ReviewAnalytical SkillsExcellent Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical EvaluationMedical Documentation ReviewDisability Claims AssessmentHealth Care Management KnowledgeAnalytical Skills
Soft Skills
Excellent CommunicationOrganizational SkillsInterpersonal SkillsCritical ThinkingTeam Collaboration
Tools & Technologies
Microsoft Office
Certifications & Qualifications
RN LicenseLVN LicenseLPN LicenseCRC CertificationCOHN CertificationCVE CertificationLPC CertificationLCSW Certification
Industry Keywords
Disability ClaimsMedical ManagementHealth Care PracticesOrthopedicsMental HealthOccupational RehabilitationInsurance ExperiencePerformance Competencies
About the role
Key responsibilities & impact- Perform standard clinical evaluations and reviews of disability claims requiring additional review
- Review medical documentation and apply clinical knowledge to substantiate disability and interpret the condition’s impact 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
- Serve as a clinical resource to claims examiners on medical terminology, medical management, and claim decisions
- Act as backup for key disability claims on an ad hoc basis
- Perform other duties as assigned
- Travel as required
Requirements
What you’ll need- Bachelor's degree or equivalent preferred
- Current RN, LVN, LPN, CRC, COHN CVE, LPC and/or LCSW licenses 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, general medicine, 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 handle work-related stress, multiple priorities, and deadlines
- Ability to sit at a desk for extended periods while operating a computer and phone system
- Travel as required
Benefits
Comp & perks- Work-life balance
- Reasonable accommodations when applicable and appropriate
- Equal Opportunity Employer
- Drug-Free Workplace