Case Management Associate

Sedgwick Claims Management Services Ltd; United States; Remote; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical plans

Dental plans

401K matching

PTO 4 weeks

Job summary

Sedgwick, a leading claims management company, seeks a Case Management Associate to access and assign workers' compensation, disability and liability cases, supporting medical staff and improving efficiency.

The role requires an associate degree or two years of college, one year of admin experience, and knowledge of ICD-9/CPT coding, with proficiency in Microsoft Office; work is team-based in a healthcare environment.

Qualifications

• Knowledge of medical and insurance terms.
• Familiarity with ICD-9 and CPT coding systems.
• Strong written and verbal communication skills.
• PC literate with Microsoft Office products.
• Analytical and detailed oriented with strong organizational skills.

Responsibilities

• Accesses and assigns cases for medical case management, utilization review and clinical consultation.
• Provides accurate information to callers based on customer requests.
• Triages telephone calls between utilization review, clinical consultation and telephonic case managers.
• Enters new claims data into the claims management system accurately; maintains data integrity.
• Supports clinical staff through the completion of components of the case management and utilization review process.
• Schedules diagnostic tests and physician appointments as assigned.
• Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
• Gathers statistics for record keeping and provides reports as required.
• Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.

Skills

ICD-9/CPT coding

Medical terminology

Oral and written communication

Analytical skills

Organizational skills

Team collaboration

Education

Associate's degree or 2 years college

Tools

Microsoft Office

Job description

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 Case Management Associate

PRIMARY PURPOSE

To access and assign workers compensation, disability and liability cases applying current policies and procedures per state workers compensation laws; and to increase efficiency of operation by providing general customer support duties and supporting the medical staff in a team environment.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Accesses and assigns cases for medical case management, utilization review and clinical consultation.
• Provides accurate information to callers based on customer requests;
• triages telephone calls between utilization review, clinical consultation and telephonic case managers.
• Enters new claims data into the claims management system accurately;
• maintains data integrity.
• Supports clinical staff through the completion of components of the case management and utilization review process.
• Schedules diagnostic tests and physician appointments as assigned.
• Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
• Gathers statistics for record keeping and provides reports as required.
• Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.

EDUCATION & LICENSING

Associate's degree or two (2) years of college preferred.

EXPERIENCE

One (1) year of administrative experience required. Customer service experience in a medical field preferred. Worker's compensation, disability and/or liability claims processing experience preferred.

SKILLS & KNOWLEDGE

Knowledge of medical and insurance terms Knowledge of ICD 9 and CPT coding systems Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills; detail-oriented Good interpersonal skills Ability to work in a team environment Ability to meet or exceed

PERFORMANCE COMPETENCIES

When applicable and appropriate, consideration will be given to reasonable accommodations.

MENTAL:

Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

PHYSICAL:

Computer keyboarding, travel as required

AUDITORY/VISUAL:

Hearing, vision and talking

TAKING CARE OF YOU

• Three Medical, and two dental plans to choose from.
• Tuition reimbursement eligible.
• 401K plan that matches 50% on every $ you put in up to the first 6% you save.
• 4 weeks PTO your first full year.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18.00-$20.00/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com