By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Utilization Review Customer Service Rep

We are hiring a Customer Service Representative to handle utilization review calls from injured workers. This role requires strong communication skills and a customer‑focused approach to ensure callers receive accurate information and support.

Schedule
We are currently hiring for the following full‑time shifts, Monday through Friday:

11:30 a.m. – 7:30 p.m. CST, or9:30 a.m. – 5:30 p.m. EST

PRIMARY PURPOSE: To assist in evaluating the medical necessity, appropriateness and efficiency of the health care services and procedures.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Assists with utilization management quality assurance initiatives through participation in on-line log and/or case staffing with supervisor.Position is to answer phones for the utilization review department.

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 One (1) year of experience with workers compensation legal and regulatory requirements and quality/managed care concepts or equivalent combination of education and experience required.

Skills & Knowledge

Knowledge of workers compensation claims procedures and state legal and regulatory requirementsGood customer service skillsGood oral and written communication skillsPC literate, including Microsoft Office productsExcellent interpersonal skillsGood organizational and time management skillsGood problem solving skillsGood analytical skillsAbility to manage multiple and changing prioritiesAbility to work in a team environment or independently with little supervisionAbility to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

TAKING CARE OF YOU BY

 We offer a diverse and comprehensive benefits package including:

Three Medical, and two dental plans to choose from.

Tuition reimbursement eligible.

401K plan that matches 50% on every $ you put in up to the first 6% you save.

4 weeks PTO your first full year.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. 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 jurisdiction noted in this job posting only, the range of starting pay for this role is $17.00-18.00/hr.  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.

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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

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.