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Specialty Ops CE II - State Fund
at Sedgwick CMS in Ohio
Specialty Operations Claims Examiner II
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 analyze low- and mid-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 low- to mid-level lost-time workers compensation claims under close supervision.
Supports other claims staff with larger or more complex claims as necessary.
Processes workers compensation claims reviewing compensability, benefits due, and files necessary documentation with state agency.
Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
Ensures claims files are properly documented and claims coding is correct.
Maintains professional client relationships.
Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.
Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
High School diploma or GED required. Licenses as required.
Experience
Eighteen (18) months claims management experience required.
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
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/18294194
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 analyze low- and mid-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 low- to mid-level lost-time workers compensation claims under close supervision.
Supports other claims staff with larger or more complex claims as necessary.
Processes workers compensation claims reviewing compensability, benefits due, and files necessary documentation with state agency.
Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
Ensures claims files are properly documented and claims coding is correct.
Maintains professional client relationships.
Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.
Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
High School diploma or GED required. Licenses as required.
Experience
Eighteen (18) months claims management experience required.
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
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/18294194
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Published on Jan 14, 2011
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Viewed: 390 times
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