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ADR Assistant
at Sedgwick CMS in Ohio
Alternative Dispute Resolution (ADR) Assistant
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE: To coordinate appeals for medical and legal issues.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
Ensures technical aspects of ADR process are completed accurately.
Enters appeals in TEAM system and Access database; forwards second level appeals to ADR Supervisor; and logs MCO decision dates in Access database.
Tracks appeals and maintains timelines in compliance with Bureau of Workers Compensation (BWC) rules; tracks exam-scheduling timeframes; and sets diary for further action as needed.
Consults with case manager and/or team lead for clinical case management direction.
Creates monthly reports for management and medical staff.
Assesses file reviews and IME reports and interprets physician recommendations for direction of medical dispute; forwards reviews with notification letter to involved parties for opportunity to appeal.
Communicates with physicians, attorneys and injured workers as directed.
Receives incoming appeals date stamping all pages.
Supports the organization's quality program(s).
QUALIFICATIONS:
Education & Licensing
High School diploma or GED required. College degree preferred.
Experience
One (1) year administrative experience required; workers' compensation and/or case management experience preferred.
Skills & Knowledge
Knowledge of medical terminology
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Good organizational skills
Flexible and detail oriented
Good customer service skills
Strong problem solving skills
Strong judgment skills
Ability to handle multiple and changing priorities
Ability to work independently and 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
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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/16247947
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE: To coordinate appeals for medical and legal issues.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
Ensures technical aspects of ADR process are completed accurately.
Enters appeals in TEAM system and Access database; forwards second level appeals to ADR Supervisor; and logs MCO decision dates in Access database.
Tracks appeals and maintains timelines in compliance with Bureau of Workers Compensation (BWC) rules; tracks exam-scheduling timeframes; and sets diary for further action as needed.
Consults with case manager and/or team lead for clinical case management direction.
Creates monthly reports for management and medical staff.
Assesses file reviews and IME reports and interprets physician recommendations for direction of medical dispute; forwards reviews with notification letter to involved parties for opportunity to appeal.
Communicates with physicians, attorneys and injured workers as directed.
Receives incoming appeals date stamping all pages.
Supports the organization's quality program(s).
QUALIFICATIONS:
Education & Licensing
High School diploma or GED required. College degree preferred.
Experience
One (1) year administrative experience required; workers' compensation and/or case management experience preferred.
Skills & Knowledge
Knowledge of medical terminology
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Good organizational skills
Flexible and detail oriented
Good customer service skills
Strong problem solving skills
Strong judgment skills
Ability to handle multiple and changing priorities
Ability to work independently and 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
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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/16247947
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Published on Jun 10, 2010
Viewed: 300 times
Viewed: 300 times
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