Medical Claims Case Manager Ii
Sedgwick CMS (St Paul, Minnesota)

This job posting has expired.

You may wish to try a search for Medical Claims Case Manager II

Or visit the FlipDog home page
 

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 recently 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 claims based on complexity, technical difficulty and/or medical management issues; to adjust disability claims; and to evaluate and arrange appropriate referral of claims to outside vendors.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

Analyzes claims based on complexity, technical difficulty and/or medical management issues Adjusts disability claims requiring medical management intervention and/or medical management Informs claimants of documentation required to process claim and timeframes if any Manages claims to ensure compliance with duration control guidelines Coordinates investigative efforts to ensure appropriateness and provide thorough review of complex, contested claims Evaluates and arranges appropriate referral of claims to outside vendors for medical case management, surveillance, and independent medical evaluation Approves and authorizes disability claims pursuant to a disability plan Determines benefits due and calculates and monitors reserves for each claim Maintains professional client relationships Communicates status on decisions to client, claimant and supervisor Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service Education & Licensing: Baccalaureate degree from an accredited college or university with degree in social work or vocational counseling or RN with active nursing license preferred Certification in rehabilitation nursing or a related specialist is preferred

Experience: Three (3) years of clinical experience required

Skills & Knowledge:

Knowledge of workers' compensation laws and regulations Excellent oral and written communication skills, including presentation skills PC literate, including Microsoft Office products Good leadership/management/motivational skills Good analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation skills Ability to work in a team environment

Sedgwick CMS is an Equal Opportunity Employer

and a

Drug-Free Workplace