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Claim Representative - Medical Only
at Sedgwick CMS in California
Specialty Risk Services
Medical Only Representative
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Specialty Risk Services, (SRS), a division of Sedgwick Claims Management Services, Inc., has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, SRS / Sedgwick CMS is the place for you.
As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, “Claim Your Future”.
PRIMARY PURPOSE:
To handle high volume of workers’ compensation medical only claims; to manage return to work process on assigned claims; and to establish and maintain effective relationships with customers.
ESSENTIAL FUNCTIONS and DUTIES
1.Handles high volume of workers’ compensation medical only claims by setting up initial claim file; ensures timely payment of medical bills; determines if there is subrogation on the file; and ensures proper processing from the onset of the claim through return-to-work process.
2.Reassigns the file if the claim becomes more complex or if there is lost time.
3.Properly diaries the claim file, issues letters, and ensures data is properly entered into appropriate system(s).
4.Establishes and maintains effective relationships with claimants, physicians, and other internal and external parties as appropriate.
ADDITIONAL FUNCTIONS and DUTIES
1.Performs other duties as assigned.
2.Supports the organization’s quality program(s).
QUALIFICATIONS
Education
BS/BA preferred.
Experience
Three (3) years of related experience required. Licensing as required.
Skills and Knowledge
· Knowledge of medical terminology
· Excellent written and oral communications skills
· PC literate, including Microsoft Office products
· Strong interpersonal skills
· Good organizational and time management skills
· Analytical and interpretive skills
· Ability to prioritize work
· 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, may be 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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
Experience with future medical claims and medical only claims preferred.
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/20878830
Medical Only Representative
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Specialty Risk Services, (SRS), a division of Sedgwick Claims Management Services, Inc., has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, SRS / Sedgwick CMS is the place for you.
As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, “Claim Your Future”.
PRIMARY PURPOSE:
To handle high volume of workers’ compensation medical only claims; to manage return to work process on assigned claims; and to establish and maintain effective relationships with customers.
ESSENTIAL FUNCTIONS and DUTIES
1.Handles high volume of workers’ compensation medical only claims by setting up initial claim file; ensures timely payment of medical bills; determines if there is subrogation on the file; and ensures proper processing from the onset of the claim through return-to-work process.
2.Reassigns the file if the claim becomes more complex or if there is lost time.
3.Properly diaries the claim file, issues letters, and ensures data is properly entered into appropriate system(s).
4.Establishes and maintains effective relationships with claimants, physicians, and other internal and external parties as appropriate.
ADDITIONAL FUNCTIONS and DUTIES
1.Performs other duties as assigned.
2.Supports the organization’s quality program(s).
QUALIFICATIONS
Education
BS/BA preferred.
Experience
Three (3) years of related experience required. Licensing as required.
Skills and Knowledge
· Knowledge of medical terminology
· Excellent written and oral communications skills
· PC literate, including Microsoft Office products
· Strong interpersonal skills
· Good organizational and time management skills
· Analytical and interpretive skills
· Ability to prioritize work
· 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, may be 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 CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
Experience with future medical claims and medical only claims preferred.
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/20878830
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