Case Management Associate
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What you'll do
- Accesses and assigns cases for medical case management, utilization review and clinical consultation.
- Provides accurate information to callers based on customer requests; triages telephone calls between utilization review, clinical consultation and telephonic case managers.
- Enters new claims data into the claims management system accurately; maintains data integrity.
- Supports clinical staff through the completion of components of the case management and utilization review process.
- Schedules diagnostic tests and physician appointments as assigned.
- Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
- Gathers statistics for record keeping and provides reports as required.
- Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.
What they're looking for
- One (1) year of administrative experience required.
Nice to have
- Associate's degree or two (2) years of college preferred.
- Customer service experience in a medical field preferred.
- Worker's compensation, disability and/or liability claims processing experience preferred.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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
Case Management AssociateAre you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
Enjoy flexibility and autonomy in your daily work, your location, and your career path.
Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE OF THE ROLE
To access and assign workers compensation, disability and liability cases applying current policies and procedures per state workers compensation laws; and to increase efficiency of operation by providing general customer support duties and supporting the medical staff in a team environment.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
Accesses and assigns cases for medical case management, utilization review and clinical consultation.
Provides accurate information to callers based on customer requests; triages telephone calls between utilization review, clinical consultation and telephonic case managers.
Enters new claims data into the claims management system accurately; maintains data integrity.
Supports clinical staff through the completion of components of the case management and utilization review process.
Schedules diagnostic tests and physician appointments as assigned.
Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
Gathers statistics for record keeping and provides reports as required.
Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.
QUALIFICATIONS
Education & Licensing: Associate's degree or two (2) years of college preferred.
Experience: One (1) year of administrative experience required. Customer service experience in a medical field preferred. Worker's compensation, disability and/or liability claims processing experience preferred.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
NEXT STEPS
If 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 $17.00 - $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.
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.
Company
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