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Case Management Coordinator - Charleston,WV
at Sedgwick CMS in West Virginia
Case Management Coordinator
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 access and assign workers compensation, disability and liability cases applying current policies and procedures per state workers compensation laws; and to increase efficiency of operation by providing general customer support duties and supporting the medical staff in a team environment.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Accesses and assigns cases for medical case management and utilization review.
Provides accurate information to callers based on customer requests; triages telephone calls between utilization review and telephonic case managers.
Enters new claims data into the claims management system accurately; maintains data integrity.
Supports clinical staff through the completion of components of the case management and utilization review process.
Schedules diagnostic tests and physician appointments as assigned
Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
Gathers statistics for record keeping and provides reports as required.
Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.
Supports other units as required.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
High school diploma or GED required.
Experience
One (1) year of administrative experience and six (6) months customer service experience required. Customer service experience in a medical field preferred. Worker's compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge
Knowledge of medical and insurance terms
Knowledge of ICD 9 and CPT coding systems
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills; detail-oriented
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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/17098841
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 access and assign workers compensation, disability and liability cases applying current policies and procedures per state workers compensation laws; and to increase efficiency of operation by providing general customer support duties and supporting the medical staff in a team environment.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Accesses and assigns cases for medical case management and utilization review.
Provides accurate information to callers based on customer requests; triages telephone calls between utilization review and telephonic case managers.
Enters new claims data into the claims management system accurately; maintains data integrity.
Supports clinical staff through the completion of components of the case management and utilization review process.
Schedules diagnostic tests and physician appointments as assigned
Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
Gathers statistics for record keeping and provides reports as required.
Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.
Supports other units as required.
Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
High school diploma or GED required.
Experience
One (1) year of administrative experience and six (6) months customer service experience required. Customer service experience in a medical field preferred. Worker's compensation, disability and/or liability claims processing experience preferred.
Skills & Knowledge
Knowledge of medical and insurance terms
Knowledge of ICD 9 and CPT coding systems
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills; detail-oriented
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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/17098841
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Published on Sep 11, 2010
Viewed: 430 times
Viewed: 430 times
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