Utilization Review Specialist

Join Sedgwick and become a vital part of an organization dedicated to making a meaningful impact in the lives of individuals facing unexpected challenges. We are seeking a Utilization Review Specialist to enhance your career while enjoying a supportive work culture and a healthy work-life balance. Here, your potential is limitless! Recognized by Newsweek as one of America's Greatest Workplaces and certified as a Great Place to Work®, Sedgwick has also been named among Fortune's Best Workplaces in Financial Services & Insurance. PRIMARY PURPOSE: To efficiently manage utilization review requests, verify and input vital data into the appropriate systems, while offering essential support to our dedicated clinical staff in a collaborative team setting. ESSENTIAL FUNCTIONS and RESPONSIBILITIES: Access, triage, and assign cases for utilization review (UR). Respond to inquiries via phone, providing accurate information and necessary triage. Enter demographics and UR data into claims or clinical management systems, ensuring data integrity. Gather all necessary information for UR processing from internal and external sources in accordance with policies and procedures. Manage incoming and outgoing correspondence, faxes, and mail; upload review documents into our paperless system as needed. Offer support to other units as required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES: Perform other duties as assigned. Contribute to the organization's quality programs. QUALIFICATIONS: Education & Licensing: High School diploma or GED is required. Experience: A minimum of two years of administrative experience or a blend of education and experience is necessary. Preference for experience in customer service within the medical field, and exposure to workers' compensation, disability, and/or liability claims processing is beneficial. Skills & Knowledge: Strong understanding of medical and insurance terminology. Familiarity with ICD9 and CPT coding is advantageous. Exceptional oral and written communication skills. Proficient in Microsoft Office and other computer applications. Strong analytical and interpretive abilities. Excellent organizational skills with a keen attention to detail. Strong interpersonal skills and the ability to collaborate effectively within a team. Able to meet or exceed performance competencies. WORK ENVIRONMENT: Reasonable accommodations will be considered when applicable and appropriate. Mental: Ability to think conceptually and clearly, exhibit excellent judgment, problem-solving skills, and handle work-related stress effectively while managing multiple priorities and meeting deadlines. Physical: Competent in computer keyboarding and able to travel as required. Auditory/Visual: Ability to hear, see and speak clearly. These statements describe the general nature and scope of work for colleagues assigned to this role. They are not intended to serve as an exhaustive list of all responsibilities, duties, or requirements. Management reserves the right to modify job duties as needed. Sedgwick is an Equal Opportunity Employer and maintains a Drug-Free Workplace. If you're excited about this role but don't meet every qualification, please consider applying anyway! Sedgwick values diversity and recognizes that each person brings a unique set of skills and experiences. You may be just the right fit for this or other opportunities. Sedgwick is a leader in risk and claims administration, helping clients navigate through the unexpected. With over 33,000 colleagues across 80 countries, we offer unparalleled insight, compassion, and innovative solutions to meet the evolving challenges of risk management.

Created: 2026-03-05