Utilization Review Coordinator

Sedgwick

28d

About The Position

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.

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
• 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
• Computer keyboarding, travel as required
• Hearing, vision and talking

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).

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees