Utilization Review Coordinator

Sedgwick Claims Management Services Ltd; Northern (KY); Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical plans

Dental plans

Vision plans

401K with matching

PTO 4 weeks

Tuition reimbursement

Life insurance

Job summary

Sedgwick is seeking an administrative specialist to support utilization review processes in a collaborative team. You will screen, triage, and assign UR cases, enter demographics and UR data into claims systems, and ensure data integrity.

You will respond to telephone inquiries, gather information from internal and external sources, and help distribute correspondence while supporting other units as needed. Requires a high school diploma and two years of admin experience; medical claims exposure

Qualifications

• Two years of administrative experience or equivalent combination of experience and education.
• Knowledge of medical and insurance terminology and coding concepts.
• Excellent communication skills, both oral and written.
• PC literate with Microsoft Office proficiency.

Responsibilities

• Accesses, triages and assigns UR cases in utilization review.
• Responds to telephone inquiries with accurate information and triage as needed.
• Enters demographics and UR data into claims or clinical management systems, maintaining data integrity.
• Gathers information required for UR processing from internal and external sources per policy.
• Distributes mail, faxes, and uploads documents into the paperless system.
• Supports other units as needed.

Skills

Medical terminology

Insurance terminology

ICD9 CPT coding

Communication skills

Office software

Microsoft Office

Analytical skills

Organizational skills

Team player

Education

High School diploma or GED

Tools

Claims system

Paperless system

Job description

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).

Education & Licensing

• High School diploma or GED required.

Experience

• Two (2) years of administrative experience or equivalent combination of experience and education required.

Preferred Qualifications

• 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

• 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.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

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