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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical evaluations and medical management of disability claims, with strong analytical, communication, and organizational skills. Holds relevant licenses and has extensive experience in healthcare management and insurance.
Highest-signal resume keywords
Current RN LicenseClinical EvaluationsMedical Documentation ReviewHealthcare Management KnowledgeAnalytical 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 ReviewHealthcare Management KnowledgeAnalytical SkillsCritical ThinkingMultitaskingPresentation SkillsMicrosoft Office ProficiencyDisability Claims ManagementMedical Terminology
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsTeam CollaborationJudgment
Certifications & Qualifications
RN LicenseLVN LicenseLPN LicenseCRC CertificationCOHN CertificationCVE CertificationLPC LicenseLCSW License
Industry Keywords
Disability ClaimsMedical ManagementHealth Care ManagementInsurance ExperienceOrthopedicsMental HealthRehabilitationSurgeryObstetricsOncology
About the role
Key responsibilities & impact- Perform standard clinical evaluations and reviews of referred disability claims
- Review medical documentation and apply clinical knowledge to substantiate disability and assess impact on job functions
- Communicate with employees and providers 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 on medical management, terminology, and claim decisions
- Provide backup for key disability claims on an ad hoc basis
- Perform other assigned duties
- 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
- Acquisition of 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, surgery, mental health, obstetrics, oncology, and rehabilitation
- Excellent oral and written communication, including presentation skills
- Proficient computer skills, including 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 considered
- Equal Opportunity Employer
- Drug-Free Workplace
- Diversity, equity, and inclusion workplace