| Job Responsibilities |
| - 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 |
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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).
| |
Technical Skills/other skills | - Computer navigation skills
- Excellent Keyboarding and data entry speed
- Knowledge about US Culture is preferred.
- Excellent verbal/written communication skills – should be able to read, interpret business documents.
- Excellent analytical and interpersonal skills
- Data gathering ability/ Eye for detail.
- Ability to comprehend and apply varied rules to multiple policies.
- Teamwork/ Managing Self / Adaptability
- Ability to work successfully and perform detail-oriented work in production driven environment.
- Excellent organizational skills
- Proven ability to meet quality and time standards.
- Ability to work on routine/standardized transactions.
- Possess strong knowledge of medical conditions, symptoms, and terminology.
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