Case Management Associate

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

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Case Management Associate

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.

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 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).

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

TAKING CARE OF YOU BY

• Offering a blended work environment.

• Supporting meaningful work that promotes critical thinking and problem solving.

• Providing on-going learning and professional growth opportunities.

• Promoting a strong team environment and a culture of support.

• Recognizing your successes and celebrating your achievements.

• Thrives when everyone is working towards the same vision/goals.

• We 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 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-$19/00/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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com