Utilization Review Coordinator

Sedgwick Claims Management Services Ltd; United States; Remote; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical plans

Dental plans

401K plan

PTO

Job summary

Sedgwick is seeking an Utilization Review Coordinator to assign UR requests, verify data, and support clinical staff in a collaborative team.

Responsibilities include triaging cases, responding to inquiries, entering UR information into claims systems, gathering required data, and assisting other units. The jurisdiction notes pay range $18-20/hr with a comprehensive benefits package.

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.

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.

Skills

Medical terminology

Insurance terminology

ICD9/CPT coding

Communication skills

Data entry

Microsoft Office

Detail oriented

Team player

Education

High School diploma or GED

Tools

Claims 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

• 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.

For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18-20.00/hr. 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. 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.

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. You may be just the right candidate for this or other roles.

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