Provider Network Specialist

📋 Description

• • As a Provider Network Specialist at Sedgwick Claims Management Services, Inc., you will play a vital role in ensuring that clients and Managed Care Organization (MCO) covered employees receive accurate information on eligibility, coverage, provider identification, procedure instructions, and regulations related to MCO services. Your work directly supports injured workers navigating the workers’ compensation system by connecting them with appropriate care and ensuring network integrity.
• • Day to day, you will work directly with clients, program managers, and injured workers to verify provider acceptance, track credentialing, communicate pre-designation rules, and maintain MCO status matrices. You will collaborate with the Medical Director and vendor partners on physician credentialing, network additions and removals, and resolve network issues by making recommendations for resolution. You will also ensure claims management system parameters are correctly set for MCO flags and respond to inquiries from clients and injured workers, escalating issues with solution recommendations when needed.
• • Sedgwick is a nationally recognized leader in claims management and productivity services, employing 33,000 colleagues dedicated to supporting people facing unexpected challenges. The company is certified as a Great Place to Work®, recognized by Newsweek as one of America’s Greatest Workplaces, and honored as a Fortune Best Workplace in Financial Services & Insurance. You will join a caring, inclusive culture that values work-life balance and professional growth.
• • In this role, you will develop deep expertise in managed care operations, healthcare regulations, and claims administration. You will strengthen your analytical, communication, and organizational skills while gaining experience in provider network management and stakeholder coordination—positioning yourself for advancement within Sedgwick’s growing healthcare and managed care divisions.