Company Detail

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

(Agile) Claims Representative - Auto

PRIMARY PURPOSE : To analyze and process low to mid-level auto and transportation claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.

• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.

• Identifies and pursues subrogation opportunities; secures and disposes of salvage.

• Communicates claim action/processing with insured, client, and agent or broker when appropriate.

• Maintains professional client relations.

• Performs coverage, liability, and damage analysis on all claims assignments.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as required.

QUALIFICATIONS

Education & Licensing

Secure and maintain the State adjusting licenses as required for the position. Having a current Home state license is a plus.

Skills & Knowledge

• Familiarity with personal and commercial lines policies and endorsements

• Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims.

• Knowledge of total loss processing, State salvage forms and title requirements.

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Good interpersonal skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: 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

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Pay Transparency:

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 $50,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Disability Clinical Specialist

PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability.

• Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.

• Makes timely, appropriate contact with employee and/or providers to discuss employee's clinical status, progress and work status.

• Achieves appropriate quality audit scores on a consistent basis.

• Acts as clinical resource to colleagues within the program.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree or equivalent preferred. RN, LVN, CRC, COHN CVD, LPC and/or LCSW preferred. Current license, registration and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations.

Experience

Four (4) years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience.

Skills & Knowledge

• Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation)

• Oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent 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, troubleshooting, problem solving, analysis, 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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Workers Compensation Claims Associate | Syracuse, NY | New England Jurisdictions

PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.

• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.

• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.

• Communicates claim action/processing with claimant, client and appropriate medical contact.

• Ensures claim files are properly documented and claims coding is correct.

• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

QUALIFICATION

Education & Licensing

High school diploma or GED required. Licenses as required.

Experience

One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills & Knowledge

• Excellent oral and written communication skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• 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, troubleshooting, problem solving, analysis, 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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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 ($17 - $24/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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

LIability Complex Claims Adjuster | Commercial Claims Experience | Remote

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.

• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

• Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.

• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

• Enjoy flexibility and autonomy in your daily work, your location, and your career path.

• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

PRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult general liability claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

• Negotiating settlement of claims within designated authority.

• Communicating claim activity and processing with the claimant and the client.

• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

Education & Licensing: 5+ years of claims management experience or equivalent combination of education and experience required.

• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.

• Professional certification as applicable to line of business preferred.

TAKING CARE OF YOU

• Flexible work schedule.

• Referral incentive program.

• Career development and promotional growth opportunities.

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Claims Examiner

PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

• Negotiates settlement of claims within designated authority.

• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

• Prepares necessary state fillings within statutory limits.

• Manages the litigation process; ensures timely and cost effective claims resolution.

• Coordinates vendor referrals for additional investigation and/or litigation management.

• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

• Ensures claim files are properly documented and claims coding is correct.

• Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as required.

QUALIFICATION

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Good interpersonal skills

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: 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

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Disability Representative Sr.

PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.

• Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.

• Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.

• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.

• Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

• Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.

• Communicates with the claimants' providers to set expectations regarding return to work.

• Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.

• Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.

• Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.

• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.

• Negotiates return to work with or without job accommodations via the claimant's physician and employer.

• Refers cases to team lead and clinical case management for additional review when appropriate.

• Maintains professional client relationships and provides excellent customer service.

• Meets the organization's quality program(s) minimum requirements.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing

High School diploma or GED required. Bachelor's degree from an accredited university or college preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations.

Experience

Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.

Skills & Knowledge

• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures

• Knowledge of state and federal FMLA regulations

• Working knowledge of medical terminology and duration management

• Excellent oral and written communication, including presentation skills

• Proficient computer skills including working knowledge of Microsoft Office

• Analytical, interpretive, and critical thinking skills

• Ability to manage ambiguity

• Strong organizational and multitasking skills

• Ability to work in a team environment

• Ability to meet or exceed performance competencies as required by program

• Effective decision-making and negotiation skills

• Ability to exercise judgement autonomously within established procedures

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental : 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

Physical : Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.

Auditory/Visual : Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

IT Security Advisor (SOC Tier 3)

PRIMARY PURPOSE : Job duties include implementing security measures to protect computer systems, network, and data, as well as triaging security alerts and serving as an escalation point for the Global Security Operation teams.

Advisors must be proficient in the latest IT and Information Security intelligence including hacker methodologies, vulnerabilities, and exploits to anticipate security shortfalls. Advisors must be experts in basic IT security fundamentals and be able to quickly master a broad range of security tools.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Detection, monitoring, analysis, and resolution of security incidents.

• Administer and train subordinates on various IT security tools and applications.

• Perform analysis of suspected malicious code and other software or programs and provide written or verbal analysis to management.

• Lead IT groups and business units as necessary in troubleshooting compatibility issues between security tools and business or productivity programs.

• Analyzes client and customer needs as required and provide clear and concise reports to leadership.

• Work closely with management on assigned projects from inception through implementation ensuring adequate internal communication and user involvement is maintained.

• Assist team members in investigating IT or cyber-security events and developing resolutions.

• Provides feedback and suggestions to management to improve IT Security processes and procedures.

• Works closely with project managers to meet and complete project milestones accurately and on time.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as needed.

QUALIFICATIONS

Education & Licensing

• Bachelor's degree in management information systems or another related field and be pursuing a master's degree in business administration or an IT related field.

Experience

• 3-5 years' experience working in a SOC (Sr. Analyst)

• 7 years' experience using various operating systems

• 7 years' experience using desktop productivity software

• Networking background (Network Topologies, TCP/IP, OSI Model)

• Access control

• Encryption technologies and algorithms

• IT Security Engineer or IT Helpdesk Supervisor experience preferred

• SPII and HIPPA data protection

• Security information and Events Management (SIEM) solutions

• Managing networked computers and servers

• Researching security threats and vulnerabilities

• Threat hunting

• Digital forensics

• MFA

• Leadership

• Audit and compliance

Preferred Experience

• Experience with Carbon Black Protection or ThreatLocker

• Experience with Microsoft Defender and Microsoft Sentinel or Google Chronicle

• Experiences with Artificial Intelligence and Machine Learning

• Researching and advising leadership on emerging security technologies

• Software Procurement

• CIS hardening

• Budgeting

• Knowledge of web proxies, preferably Zscaler ZIA

Skills & Knowledge

• Ability to work independently and solve problems as they arise

• Ability to handle confidential and sensitive information with integrity

• Ability to continuously learn new technologies

• Ability to guide collaboration with team members to achieve goals

• CIA triad expertise

• Information Technology Security frameworks expertise

• Strong written and verbal skills

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: 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

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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, troubleshooting, problem solving, analysis, 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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

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• Company:
  Sedgwick