Technical Standards and Compliance Advisor

October 30

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Sedgwick

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claims management • risk management • workers'​ compensation • disability • absence solutions

10,000+

Description

• To ensure product quality and compliance with regulatory requirements and serve as a resource to office operations with a focus on achieving timely and accurate delivery of benefits and notices to mitigate penalties and legal claim exposures and other adverse actions. • Develops and reviews management reports related to claim processes or decisions that are subject to legal and regulatory compliance. • Develops training programs and technical support material to monitor and prevent legal and regulatory claim handling exposures. • Consults with Sedgwick University as needed in the development and delivery of training programs consistent with these objectives. • Participates in round table review of claim strategy and makes recommendations that are consistent with legally compliant file handling standards. • Assists with projects focused on process, procedural and/or compliance changes/updates; may be involved in the communication of changes/updates to field offices, IT, Legal and other applicable business units. • Prepares offices for regulatory audits, participates in debriefings as needed, and assists in the development of rebuttal positions. • Acts as a liaison to state auditors and operations. • Educates colleagues, managers and/or clients regarding state regulatory matters and assist with the resolution of regulatory/compliance issues. • Works closely with internal quality programs and practice leads to share information and prepares mitigation strategies. • Ensure consistent adoption of required forms, procedures and legally compliant practices by all business unit offices.

Requirements

• Bachelor's degree or equivalent from an accredited college or university preferred • Ten (10) years of claims management and/or other related experience or equivalent combination of education and experience required • In depth knowledge of regulatory claims management, managed care and/or absence management processes and procedures • Excellent oral and written communication, including presentation skills • PC literate, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Excellent interpersonal skills • Excellent negotiation skills • Ability to work in a team environment • Ability to meet or exceed Performance Competencies

Benefits

• medical • dental • vision • 401k and matching • PTO • disability and life insurance • employee assistance • flexible spending or health savings account • other additional voluntary benefits