Utilization Review Coordinator

Sedgwick Claims Management Services Ltd; Florida; On-site; USD 25,000 - 28,000; Full time

Job summary

Sedgwick is hiring an Utilization Review Coordinator in the United States. You will assign UR requests, verify data in the claims or clinical management systems, and provide support to clinical staff in a collaborative team environment.

The ideal candidate has two years of administrative experience in a medical setting, knowledge of medical terminology, and proficiency with ICD9/CPT coding and Microsoft Office.

Qualifications

• High School diploma or GED required.
• Two years of administrative experience or equivalent.
• Customer service in medical field preferred.
• Workers' compensation, disability and/or liability claims processing experience preferred.

Responsibilities

• Assigns utilization review cases and triages them within established procedures.
• Responds to telephone inquiries with accurate information and triages as needed.
• Enters demographics and UR information into claims or clinical management systems; maintains data integrity.
• Obtains all necessary information for UR processing from internal and external sources per policies.
• Distributes incoming and outgoing correspondence and uploads review documents into the paperless system.
• Supports other units as needed and contributes to the quality program.

Skills

Medical terminology

Insurance terminology

ICD9 coding

CPT coding

Communication skills

Microsoft Office

Data entry

Education

High School diploma or GED

Tools

Office software

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 CompaniesCertified as a Great Place to WorkFortune Best Workplaces in Financial Services & InsuranceUtilization Review CoordinatorPRIMARY 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 RESPONSIBILITIESAccesses, 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 RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).QUALIFICATIONSEducation & LicensingHigh School diploma or GED required.ExperienceTwo (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 & KnowledgeKnowledge of medical and insurance terminologyKnowledge of ICD9 and CPT codingExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsDetail OrientedGood interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen 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.NEXT STEPSIf your application is selected to advance to the next round, a recruiter will be in touch.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.