Case Management Associate - Sedgwick Claims Management Services, Inc.

PRIMARY PURPOSE: 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 FUNCTIONS and RESPONSIBILITIES
 

• 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

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.

Skills & Knowledge

• Knowledge of medical and insurance terms
• Knowledge of ICD 9 and CPT coding systems
• 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.

Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual:  Hearing, vision and talking

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.

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 ($14.00 - $18.00). 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