336 disability clinical specialist jobs found

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. Provides clear and appropriate...

As the Clinical Specialist LPN/RN, Disability Claims you will perform necessary outreaches to claimants or treating providers to obtain certification dates, treatment plans and any other pertinent medical information necessary to facilitate and assist claims managers in adjudicating disability claims decision. They will leverage their medical knowledge to determine what medical information is needed and perform the necessary steps needed to obtain this information. This individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to facilitate timely claim decisions. You are Knowledgeable in a variety of medical and behavioral health conditions Vendor management: Works collaboratively with vendors to schedule and follow up for vendor reports Excellent written and verbal communication skills Ability to exercise independent & sound judgment in decision making...

Job Description: Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead – our policyholders count on us to be there when it matters most. It’s a big ask, but it’s one that we have the power to deliver when we work together. We collaborate and innovate – pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it’s the right thing to do. Pacific Life is more than a job, it’s a career with purpose. It’s a career where you have the support, balance, and resources to make a positive impact on the future – including your own.    We’re actively seeking a talented Senior Supplemental Health Claims Specialist to join our Team in Newport Beach, CA; Omaha, NE or remote in Chattanooga, TN. As a Senior Supplemental Health Claims Specialist you'll move Pacific Life and your career, forward by administering complex Supplemental Health and other voluntary benefits claims. You'll fill an...

Company Details   Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.   To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an...

Company: Marsh McLennan Agency Description: Peak Health is seeking Customer Service Representative in Wilson, NC Peak Health  is a subsidiary of one of the nation’s largest insurance brokers, McGriff, that employs clinically-based lifestyle and behavior change programs led by registered nurses who provide health risk assessments, help employees navigate wellness offerings, and drive individual accountability of health through personalized coaching to help employers get control over their healthcare costs. Peak Health is a recognized behavioral change and nurse coaching leader in the industry. Our company was founded in 1989 by two nurse practitioners who wanted to improve employee health behaviors. With over 35 years of results and impact, touching the lives of 100,000+ participants with clinical programming, check out this case study that highlights our proven results to understand why we do what we do! ADDITIONAL INFORMATION (all positions):  **Company...

Job Description: Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead – our policyholders count on us to be there when it matters most. It’s a big ask, but it’s one that we have the power to deliver when we work together. We collaborate and innovate – pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it’s the right thing to do. Pacific Life is more than a job, it’s a career with purpose. It’s a career where you have the support, balance, and resources to make a positive impact on the future – including your own.    We’re actively seeking a talented Senior Claims Specialist - Short Term Disability join our Workforce Benefits Team in Newport Beach, CA, Omaha, NE or remote in Chattanooga, TN. As a Senior Claims Specialist - Short Term Disability, you’ll move Pacific Life, and your career, forward by leading the end-to-end adjudication of complex Short Term Disability...

Position Summary: The DRG Audit Program Director is a strategic and operational leader responsible for the development, implementation, and oversight of all DRG clinical validation and audit initiatives. This role ensures the integrity of healthcare payments by identifying and recovering improper payments, optimizing DRG assignments, and driving process improvements to enhance coding accuracy, documentation completeness, and compliance. The Director leads a team of clinical and coding auditors and collaborates cross-functionally with various departments to achieve organizational goals.   Key Responsibilities: Strategic Planning & Vision: Develop and execute strategic plans for the DRG audit program, aligning with broader organizational objectives, industry trends, and regulatory changes (e.g., MS-DRG, APR-DRG, ICD-10-CM/PCS). Identify emerging risks and opportunities related to DRG assignments and develop proactive strategies to address them....

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim, Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors,...

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we’ve built deep relationships with approximately 30 thousand companies that are key to the...

Company Details   Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.   To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an...

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues.   This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims  with precision Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners. Performs contract and reimbursement variance analysis. Analyzes claims data to...

Primary Details Time Type: Full time Worker Type: Employee The Opportunity: This role will support the Claims Manager in managing assumed reinsurance excess of loss and proportional business for QBE Reinsurance's A&H portfolio, ensuring proper reporting and documentation of all claims following reinsurance contract terms. The Lead Claims Specialist will perform complex claims review by conducting claims data analyses, health and billing records assessments and validation of eligible benefits and losses under the plan contracts. The role will assure timely and accurate reserves are approved and recorded. Adjudicate claim payments within approved authority level and refer complex claims for clinical review when appropriate. Provide effective communications, data support, and collaboration with Global Claim department, Underwriting, Actuary, Legal and other internal teams. Participate in program management and provide claims support to external clients, brokers,...

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.   Job Description: Location: We support US flexible working arrangements in the contiguous 48 states.      At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self...

Company: Marsh McLennan Agency Description: Workers’ Health Clinical Consultant Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. More than 11,000 of the industry’s brightest talents drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can thrive as a Workers’ Health Clinical Consultant at Marsh McLennan Agency (MMA). MMA provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With more than 200 offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). A day in the life. As our Workers' Health Clinical Consultant , on...

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim, Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors,...