Assistant Claims Examiner Jobs in Raleigh, NC (NOW HIRING)

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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PRN Crisis Care Triage (RN)

Sedgwick is currently seeking Triage Nurses to join our Crisis Care team. This is a remote PRN position offering up to 20 hours per week. The team operates 24/7, with the greatest staffing needs during afternoon, evening hours, overnight and weekends.

Current shift needs (CST) are:

• 9:00 PM to 6:00 AM, Monday through Friday

• 6:00 AM to 6:00 PM, Saturday and Sunday

• 6:00 PM to 6:00 AM, Saturday/Sunday

As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting.

• Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.

• Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment.

• Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.

• Enable our Caring counts® mission supporting injured employees from some of the world's best brands and organizations.

• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

• Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.

• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

PRIMARY PURPOSE : Triages incoming catastrophic injury referral calls from clients; gathers vital case details, obtains and provides medical status updates to the customer, and assigns a Field Case Manager (FCM) for onsite visits as appropriate. Ensures that client service guidelines are followed and communicated to the appropriate parties and promotes quality cost-effective outcomes through communication and available resources.

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 RESPONSIBLITIES MAY INCLUDE:

• Provides professional and timely responses to incoming catastrophic referral calls from clients, applying all phases of the nursing process, i.e. assessment, planning, implementation, and evaluation when triaging calls.

• Triages the catastrophic referral utilizing critical reasoning, the department triage log, and associated workflow; utilizes customer specific guidelines to obtain pertinent data.

• Identifies life-threatening emergencies and recommends appropriate interventions.

• Assigns appropriate Field Case Manager assignment and facilitates initial onsite hospital visit for the claim.

• Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and FCM estimated time of arrival.

• Communicates phone advice in a calm manner, ensuring it is properly received and understood.

• Ensures triage benchmarks are met, activity is professionally documented and enters incident data into computer system.

• Educates the assigned FCM on Sedgwick benchmarks and customer specific guidelines.

• Maintains ongoing communication with the client, Client Service Director, and Claims Examiner until the assigned Field Case Manager arrives onsite.

• Adheres to quality assurance standards.

Education & Licensing

Bachelor's degree in nursing (BSN) from an accredited college or university preferred. Licenses as required. Active unrestricted RN license issued in a state or territory of the United States required.

TAKING CARE OF YOU

• Seeks innovative customer solutions.

• Craves cutting edge opportunities.

• Wants dynamic company culture.

• Passion about creativity.

• Seeks ongoing learning as a person and professional.

• Thrives when solving challenging problems.

• Wants achievements to be celebrated.

• We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

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 $23 - 25.00/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.

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com