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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 claim decisions.
Highest-signal resume keywords
Current RN, LVN, LPN, CRC, COHN, CVE, LPC, LCSW LicensesFour Years Related ExperienceKnowledge of Current Medical PracticesExcellent Oral and Written CommunicationProficient Computer 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 EvaluationsMedical Documentation ReviewDisability Claims AssessmentAnalytical SkillsCritical Thinking Skills
Soft Skills
Strong Organizational SkillsInterpersonal SkillsMultitasking SkillsJudgment SkillsTeam Collaboration
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Bachelor's Degree or EquivalentCurrent Licenses and Registrations
Industry Keywords
Health Care ManagementOrthopedicsGeneral MedicineMental HealthOccupational Rehabilitation
About the role
Key responsibilities & impact- Perform standard clinical evaluations and reviews of referred disability claims requiring additional review
- Review medical documentation and apply clinical knowledge to substantiate disability and interpret the impact of conditions on job functions
- Communicate with employees and providers by phone and/or in writing regarding clinical status, progress, and work status
- Provide follow-up recommendations for ongoing medical management of claims
- Achieve appropriate quality audit scores
- Act as a clinical resource to claims examiners, providing guidance on medical terminology and claim decisions
- Serve 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 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
- Diverse, equitable, and inclusive workplace
- Equal Opportunity Employer
- Drug-Free Workplace