Utilization Review Coordinator

Sedgwick; Tallahassee (FL); Remote; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical plans

Dental plans

401(k) plan

PTO – 4 weeks

Tuition reimbursement

Job summary

Sedgwick is seeking an Utilization Review Coordinator to assign UR requests, verify data, and support clinical staff in a collaborative team. The role involves data entry, case triage, and responding to inquiries to ensure accurate UR processing.

The ideal candidate brings administrative experience in a medical environment, knowledge of ICD9/CPT, and strong communication and organizational skills. This telecommuter position offers comprehensive benefits and a supportive culture.

Qualifications

• High School diploma or GED required.
• Two years of administrative experience; customer service in medical field preferred.
• Workers compensation, disability and/or liability claims processing experience preferred.
• Knowledge of ICD9 and CPT coding; familiarity with medical terminology.

Responsibilities

• Accesses, triages and assigns cases for utilization review (UR).
• Responds to telephone inquiries with 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.
• Performs other duties as assigned.
• Supports the organization’s quality program(s).

Skills

Medical terminology

Insurance terminology

ICD9/CPT coding

Communication skills

PC literacy

Analytical skills

Organizational skills

Detail oriented

Interpersonal skills

Team player

Education

HS diploma or GED

Job description

US Telecommuter

R77683

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.

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