Utilization Review Coordinator

Sedgwick; Florida; Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Tuition reimbursement eligible.

401K plan that matches 50% on every $你

4 weeks PTO your first full year.

Job summary

Sedgwick in Florida is seeking an Utilization Review Coordinator to support clinical staff by assigning UR requests, verifying data, and entering information into the appropriate systems. This role emphasizes accuracy, teamwork, and timely processing in a busy healthcare environment.

Ideal candidates bring at least two years of admin experience in medical settings, familiarity with ICD9/CPT terminology, and strong communication skills.

Qualifications

• High School diploma or GED required.
• Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred.
• Knowledge of medical and insurance terminology; ICD9 and CPT coding.
• Excellent oral and written communication, including presentation skills.
• PC literate; Microsoft Office products; data entry and accuracy focus.

Responsibilities

• Accesses, triages and assigns cases for utilization review (UR).
• Responds to telephone inquiries providing accurate information and triage as necessary.
• Enters demographics and UR information into claims or clinical management system; maintains data integrity.
• Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
• Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
• Supports other units as needed.

Skills

Medical terminology

ICD9/CPT coding

Oral and written communication

Analytical skills

Organizational skills

Detail oriented

Interpersonal skills

Team work

Performance competencies

Microsoft Office

Education

High School diploma or GED

Tools

Microsoft Office

Clinical management system

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

Utilization Review Coordinator

PRIMARY PURPOSE : To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical 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, triages and assigns cases for utilization review (UR).
• Responds to telephone inquiries proving accurate information and triage as necessary.
• Enters demographics and UR information into claims or clinical management system; maintains data integrity.
• Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
• Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
• Supports other units as needed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
High School diploma or GED required.

Experience
Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.

Skills & Knowledge
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
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

WORK ENVIRONMENT

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

TAKING CARE OF YOU BY

• 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 $18-20.00/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.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is 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.