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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 documentation review, applying knowledge in health care management and disability claims. Proficient in communication and collaboration with employees and providers to manage claims effectively.
Highest-signal resume keywords
Current RN LicenseClinical EvaluationsMedical Documentation ReviewHealth Care ManagementAnalytical 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 ReviewHealth Care ManagementAnalytical SkillsCritical ThinkingMultitaskingPresentation SkillsMicrosoft Office ProficiencyDisability Claims ManagementKnowledge of Medical Practices
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsTeam CollaborationJudgment
Certifications & Qualifications
RN LicenseLVN LicenseLPN LicenseCRC CertificationCOHN CertificationCVE CertificationLPC CertificationLCSW Certification
Industry Keywords
Disability ClaimsMedical Claims ManagementHealth Care ManagementOrthopedicsMental HealthOccupational RehabilitationInsurance ExperiencePhysical Industrial MedicineGeneral MedicineOncology
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 claim management, terminology, and claim decisions
- Provide 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 licenses and designations through necessary CEUs
- 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