PRIMARY PURPOSE: To support and maintain the claims management system for a local office or multiple office locations; and to ensure security access meets established policies within assigned group.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Completes examiner update reports, claim adjustments, provider requests and operational expense check requests.
• Queues claims for Managed Care; transfers payment allocations; and runs manual pre-pay and balances as requested.
• Creates and maintains internal and external logins and the applicable security access for the company's claims management systems by determining the validity for incoming requests and whether they meet established policies.
• Coordinates with company's internal audit group to ensure security access is defined and implemented according to established policies and procedures.
• Communicates and collaborates with other internal departments to support the security needs of end-users.
• Researches and gathers data as needed for auditing, special projects or returned checks.
• Provides telephone support to end-users.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
High School diploma or GED required. Associate degree preferred.

Experience
Two (2) years of claims management or insurance experience or equivalent combination of education and experience required.

Skills & Knowledge

• Excellent oral and written communication, including presentation 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

NOTE: Credit security clearance, confirmed via a background credit check, is 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.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (17.00-19.50 per hour) A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.