Utilization Review Coordinator

Sedgwick

19h

About The Position

Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides expertise, advanced AI-enabled technology, and a caring culture. The company has been recognized as one of America’s Greatest Workplaces by Newsweek, a National Top Company Certified as a Great Place to Work®, and among Fortune Best Workplaces in Financial Services & Insurance. The primary purpose of the Utilization Review Coordinator role is to assign utilization review requests, verify and enter data into appropriate systems, and provide general support to clinical staff in a team environment. Sedgwick invites individuals to grow their career, experience their caring culture, and enjoy work-life balance.

Requirements

High School diploma or GED required.
Two (2) years of administrative experience or equivalent combination of experience and education required.
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

Nice To Haves

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.
Performs other duties as assigned.
Supports the organization's quality program(s).