Description

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.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Workers Compensation Compliance Specialist

PRIMARY PURPOSE: To ensure the company's regulatory standards compliance; to track and report state regulatory violations by tracking, responding, and disputing; and to ensure good relationships with state regulators.

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

• Creates and maintains relationships with state regulators in order to further company's reputation and standing with the state(s).
• Maintains working knowledge of state regulatory system and keeps abreast of state regulatory fee schedule changes and enhancements.
• Identifies, develops, and assists in delivery of colleague training on state system compliance issues and enhancements to current systems regarding medical bill review.
• Identifies appropriate bill review system enhancements to improve compliance; requests enhancements as appropriate.
• Works with state workers compensation agencies as appropriate.
• Provides required reporting on claims, penalty and compliance issues to ensure compliance within the state(s).
• Acts as the primary liaison between company and carrier partners on specific issues of penalties within the jurisdiction.
• Assists in delivery of focused jurisdictional compliance training.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred.

Experience
Four (4) years of related experience or equivalent combination of education and experience required. Experience in claims management, call center, medical bill review or managed care preferred.

Skills & Knowledge

• Thorough knowledge of state regulatory compliance standards
• Good knowledge of claim management system
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Ability to work independently or in a team environment
• Ability 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 $45,000 - $60,000/year. 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.