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· Provides professional medical, technical, consulting advice, and recommendations in support of claims evaluation, investigation, and assessment for various claims-related departments, while managing assigned caseload of complex case applying specialized training and knowledge to the assessment of cases and acting as a resource on clinical and technical issues. · Conducts complex research, review and analysis of medical records, treatment plans and claim information. · Provides recommendations regarding claimants’ current potential functional abilities and develops goal-focused return-to-work plans. · Assess training needs and creates, authors, and presents medical training to claim and business partner associates. · Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining functional abilities. · Engages claimants, health care providers and employers in return to work potential and planning while coaching claim specialists on identifying and acting upon return-to-work potential. · Creates effective requests for medical information which focus on clarifying medical restrictions and limitations and their impact on work functionality. Performs other related duties as assigned or required

Education, Technical Skills & Other Critical Requirement

Education Bachelor’s degree (Medical) or diploma with a minimum of 15 years of education.

Experience

(In Years) Required · Current RN licensure · 4+ years of experience as an RN with Clinical/Ops Experience Preferred · 7+ years Disability claims and/or clinical experience. · Disability claims experience · Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).