Provider Credentialing Specialist

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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. Its an opportunity to do something meaningful, each and every day. Its 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 youre someone who cares, theres a place for you here. Join us and contribute to Sedgwick being a great place to work.

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Provider Credentialing Specialist

PRIMARY PURPOSE: As a Credentialing Specialist with Sedgwick, you will build provider and facility credentialing files to submit for review and approval by the company's Medical Directors, ensuring compliance with internal policies, external regulatory agencies, and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Receives and reviews new provider and facility credentialing applications from the Sedgwick contracting team.

• Receives monthly files inclusive of contracted providers and facilities to recredential and submit for approval.

• Contacts provider groups to request any missing required supporting documents.

• Reviews documentation and, using approved primary sources, to build the provider file and summarize findings for review by Sedgwicks Medical Directors.

• Responds to providers regarding the status of their application.

• Responds to providers questions regarding Sedgwicks credentialing requirements and procedures.

• Attends monthly Credentialing Committee meetings and responds to questions regarding provider credentialing.

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.

Experience

• Two (2) years credentialing experience or equivalent combination of education and experience required.

• Experience in healthcare preferred.

• Experience in the commercial health insurance or worker's compensation field highly preferred.

Skills & Knowledge

• Strong customer service and telephone skills

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Strongly detail oriented

• Analytical and interpretive skills

• Strong organizational skills

• Excellent negotiation skills

• Ability to work independently in a team environment

• Ability to take initiative and follow through

• Ability to manage multiple priorities

• 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; ability to meet deadlines.

Physical: Computer work, sitting.

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.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in telecommuter. 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 state noted in this job posting only, the range of starting pay for this role is ($18.66-$26.28). 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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing one where caring counts. Watch this video to learn more about us. ([ Link removed ] - Click here to apply to Provider Credentialing Specialist

Salary : $19 - $26