Triage Associate - Sedgwick Claims Management Services, Inc.
OH, OH
About the Job
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®
Most Loved Workplace®
Forbes Best-in-State Employer
Triage Associate
PRIMARY PURPOSE: To provide initial research/data collection on new workers compensation (WC) claims; to assist in prompt and accurate reporting of required and situational claim data elements to the Bureau of Workers Compensation (BWC) via electronic data transmission; and to receive, review and research new claim EDI transmission from BWC.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Receives notices of new claims via telephone, BWC-EDA-148 transmissions, or first report of injury (FROI) through FROI form, C-9, and other documentation; and receives, reviews and researches FROI reports to obtain required and situational data elements to facilitate initial EDI to BWC.
- Receives, reviews and researches new EDI transmissions from BWC to identify case acuity level and refers to disability management per CHS policy; initiates first EDI on new claim within four (4) calendar days.
- Communicates with service provider, injured worker and employer to obtain accurate data elements for evaluation and identification of acuity level.
- Identifies appropriate staff to facilitate prompt assignment of new claims.
- Identifies barriers to a return-to-work (RTW) status as they relate to the functional requirements of the injured worker's job duties.
- Identifies appropriate referrals for Remain-at-Work and Vocational Rehabilitation Services; communicates this to assigned staff.
- Educates employers to expedite early communications for FROI and RTW Services through CHS medical case management process.
- Maintains current knowledge of BWC rules/laws, WC process and CHS policies and procedures.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality programs.
QUALIFICATIONS
Education & Licensing
High School diploma or GED required. Licenses as required.
Experience
One (1) year of general office experience or equivalent combination of education and experience required. Insurance industry experience preferred.
Skills & Knowledge
- Excellent oral and written communication
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Ability to provide accurate and prompt research
- Ability to provide confirmation for identification of the Degree of Disability Management (DoDM)
- 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
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 is an Equal Opportunity Employer and a Drug-Free Workplace.
