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Case Examiner I - Disability Management
at Sedgwick CMS in Ohio
Case Examiner I
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 identify expected elements on Electronic Data Interchange (EDI) to the Bureau of Workers Compensation (BWC); to obtain medical documentation for confirmation of claim allowance and release date for full return to work; and to manage acuity level II and III claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Obtains expected elements for subsequent EDI to the BWC.
Verifies full return to work documentation through telephone and written communications.
Makes referral for case management and/or utilization management when full duty status changes due to functional limitations.
Documents communications in appropriate system(s).
Responds to BWC inquiries within one (1) business day.
Maintains knowledge of BWC rules and laws, workers compensation process, and CHS policies and procedures.
Manages acuity level II and III claim quality assurance initiatives by identifying complains or compliments through online log.
Supports the total performance management initiative.
Education & Licensing
High School diploma or GED required.
Experience
One (1) year administrative experience required. One (1) year case management experience preferred.
Skills & Knowledge
Knowledge of BWC Mandatory and Expected EDI Transmission elements
Good oral and written communication skills
PC literate, including Microsoft Office products
Good organizational and time management skills
Good customer service skills
Ability to work independently and in a team environment
Ability to manage multiple and changing priorities
Decision making/problem solving skills
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/15396531
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 identify expected elements on Electronic Data Interchange (EDI) to the Bureau of Workers Compensation (BWC); to obtain medical documentation for confirmation of claim allowance and release date for full return to work; and to manage acuity level II and III claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Obtains expected elements for subsequent EDI to the BWC.
Verifies full return to work documentation through telephone and written communications.
Makes referral for case management and/or utilization management when full duty status changes due to functional limitations.
Documents communications in appropriate system(s).
Responds to BWC inquiries within one (1) business day.
Maintains knowledge of BWC rules and laws, workers compensation process, and CHS policies and procedures.
Manages acuity level II and III claim quality assurance initiatives by identifying complains or compliments through online log.
Supports the total performance management initiative.
Education & Licensing
High School diploma or GED required.
Experience
One (1) year administrative experience required. One (1) year case management experience preferred.
Skills & Knowledge
Knowledge of BWC Mandatory and Expected EDI Transmission elements
Good oral and written communication skills
PC literate, including Microsoft Office products
Good organizational and time management skills
Good customer service skills
Ability to work independently and in a team environment
Ability to manage multiple and changing priorities
Decision making/problem solving skills
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/15396531
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Published on Mar 09, 2010
Viewed: 187 times
Viewed: 187 times
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