Medicare Specialist (Remote)

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.

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Medicare Specialist (Remote)

PRIMARY PURPOSE : To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Compiles, reviews and analyzes claim files and / or management reports.
• Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses’ analysis.
• Requests rated-ages; tracks files / requests / submissions through Centers for Medicare and Medicaid Services (CMS) processes;

and creates documentation as required.

• Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and / or general information.
• Maintains thorough understanding of service and products offered by Medicare Compliance department.
• Analyzes and processes complex claims by investigating and gathering information to determine the exposure on the claims;

manages claims through well-developed action plan to an appropriate and timely resolution.

Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and / or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Four (4) years claims management experience or equivalent combination of experience and education required. Experience with Medicare issues preferred.

Skills & Knowledge

• Thorough knowledge of claims management
• Excellent oral and written communication, including persuasive writing skills
• PC literate, including Microsoft Office products
• Strong analytical and interpretive skills
• Strong organizational skills
• Strong 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

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.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

You may be just the right candidate for this or other roles.