Utilization Review Coordinator

Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.

Accesses, triages and assigns cases for utilization review (UR). Responds to telephone inquiries proving accurate information and triage as necessary. Enters demographics and UR information into claims or clinical management system; maintains data integrity. Obtains all necessary information required for UR processing from internal and external sources per policies and procedures. Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary. Supports other units as needed. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).