Case Management Associate

Sedgwick; Stati Uniti; Remoto; USD 25.000 - 28.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical plans

Dental plans

Vision insurance

401K plan with company match

PTO (paid time off)

Descrizione del lavoro

Sedgwick is hiring a Case Management Associate in the United States to support medical case management, utilization review and clinical consultation. You will handle case assignments, data entry, and coordination with clinicians to ensure efficient, compliant processes.

The role requires an associate degree (or two years of college) and at least one year of administrative experience, preferably in a medical claims environment. A focus on data integrity and strong communication is essential.

Competenze

• Associate's degree or two (2) years of college preferred.
• One (1) year of administrative experience required; customer service in medical field preferred.
• Knowledge of medical and insurance terms.
• PC literate, including Microsoft Office products.
• Experience with workers' compensation, disability and/or liability claims processing preferred.

Mansioni

• Accesses and assigns cases for medical case management, utilization review and clinical consultation.
• 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 components of the case management and utilization review process.
• Schedules diagnostic tests and physician appointments as assigned.
• Directs injured workers, employers and examiners to appropriate PPO network for treatment.
• Gathers statistics for record keeping and provides reports as required.
• Ensures required fax forms and filings have been received and distributed.

Conoscenze

Medical terms

ICD9/CPT coding

Communication skills

MS Office

Analytical ability

Organization

Interpersonal skills

Team player

Performance competencies

Formazione

Associate's degree or 2 years of college

Descrizione del lavoro

Case Management Associate

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

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.

ARE YOU AN IDEAL CANDIDATE?

We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

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 BY

• Offering a blended work environment.
• Supporting meaningful work that promotes critical thinking and problem solving.
• Providing on-going learning and professional growth opportunities.
• Promoting a strong team environment and a culture of support.
• Recognizing your successes and celebrating your achievements.
• Thrives when everyone is working towards the same vision/goals.
• We offer a diverse and comprehensive benefits package including:
  • 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.

Sedgwickis an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! 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.