Utilization Review Coordinator

Utilization Review CoordinatorBy 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.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 RESPONSIBILITIESAccesses, 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 RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).QUALIFICATIONSEducation & 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 & KnowledgeKnowledge of medical and insurance terminologyKnowledge of ICD9 and CPT codingExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsDetail OrientedGood interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.TAKING CARE OF YOU BYWe offer a diverse and comprehensive benefits package including: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.NEXT STEPSIf your application is selected to advance to the next round, a recruiter will be in touch.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.