Taking care of people is at the heart of everything we do, and westart by taking care of you, our valued colleague. A career at Sedgwickmeans experiencing our culture of caring. It means having flexibility andtime for all the things that are important to you. It’s an opportunity todo something meaningful, each and every day. It’s having support for yourmental, physical, financial and professional needs. It means sharpeningyour skills and growing your career. And it means working in an environmentthat celebrates diversity and is fair and inclusive.A career at Sedgwick is where passion meets purpose to make a positiveimpact on the world through the people and organizations we serve. If youare someone who is driven to make a difference, who enjoys a challenge andabove 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 EmployerMedicare Specialist (Remote)PRIMARY PURPOSE: To coordinate, analyze and facilitateMedicare Compliance and Medicare Set-Aside (MSA) functions within theassigned team.ESSENTIAL FUNCTIONS And RESPONSIBILITIESCompiles, reviews and analyzes claim files and/or managementreports.Compiles and organizes medical records; distributes to MedicareCompliance nurses for analysis; and provides guidance and advice onprocessing claims based on nurses’ analysis.Requests rated-ages; tracks files/requests/submissions through Centersfor Medicare and Medicaid Services (CMS) processes; and createsdocumentation as required.Communicates and advises appropriate internal and external stakeholderson Medicare Compliance and Medicare Set-Aside (MSA) matters including, butnot limited to, lien negotiation efforts, MSA submissions and/or generalinformation.Maintains thorough understanding of service and products offered byMedicare Compliance department.Analyzes and processes complex claims by investigating and gatheringinformation to determine the exposure on the claims; manages claims throughwell-developed action plan to an appropriate and timely resolution.Analyzes lien notices for accuracy, communicates with the CMS toefficiently facilitate lien resolutions on claims and/or prepare MSAsubmissions in accordance with submission guidelines from CMS as assigned.ADDITIONAL FUNCTIONS And RESPONSIBILITIESPerforms other duties as assigned.Supports the organization’s quality program(s).Travels as required.QualificationsEducation & LicensingBachelor’s degree from an accredited college oruniversity preferred.ExperienceFour (4) years claims management experience or equivalentcombination of experience and education required. Experience with Medicareissues preferred.Skills & KnowledgeThorough knowledge of claims managementExcellent oral and written communication, including persuasive writingskillsPC literate, including Microsoft Office productsStrong analytical and interpretive skillsStrong organizational skillsStrong interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given toreasonable accommodations.Mental: Clear and conceptual thinking ability;excellent judgment, troubleshooting, problem solving, analysis, anddiscretion; ability to handle work-related stress; ability to handlemultiple priorities simultaneously; and ability to meet deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingThe statements contained in this document are intended to describe thegeneral nature and level of work being performed by a colleague assigned tothis description. They are not intended to constitute a comprehensive listof functions, duties, or local variances. Management retains the discretionto add or to change the duties of the position at any time.As required by law, Sedgwick provides a reasonable range ofcompensation for roles that may be hired in jurisdictions requiring paytransparency in job postings. Actual compensation is influenced by a widerange of factors including but not limited to skill set, level ofexperience, and cost of specific location. For the jurisdiction noted inthis job posting only, the range of starting pay for this role is$54,000 to $61,000. A comprehensive benefitspackage 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 voluntarybenefits.Sedgwick is an Equal Opportunity Employer and a Drug-FreeWorkplace.If you’re excited about this role but your experiencedoesn’t align perfectly with every qualification in the jobdescription, consider applying for it anyway! Sedgwick is building adiverse, equitable, and inclusive workplace and recognizes that each personpossesses a unique combination of skills, knowledge, and experience. Youmay be just the right candidate for this or other roles. Show more Show lessTagged as: remote, remote job, virtual, Virtual Job,virtual position, Work at Home, work from home