Claims Manager – Technical Standards and Compliance - Sedgwick Claims Management Services, Inc.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®
Most Loved Workplace® 
Forbes Best-in-State Employer

Claims Manager – Technical Standards and Compliance

PRIMARY PURPOSE:  To ensure product quality and regulatory standards compliance by line-of-business; to establish policies and procedures; and to develop and train colleagues on technical components of new programs.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Establishes policies and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements on new programs.
• Analyzes management reports related to new program performance and quality; mentors new colleagues to improve performance as needed.
• Maintains complete understanding of new program design, processes, client expectations and partner relationships; makes recommendations for improvements; and develops best practices for disability and leave operational processes.
• Serves as subject matter expert responsible for the training of technical processes and requirements; leads training initiatives for colleagues, supervisors/managers and clients as needed.
• Leads projects focused on large process, procedural and /or compliance changes/updates; communicates changes/updates to field offices, IT, Legal and other applicable business units regarding regulatory requirements and changes.
• Plays key role in maintaining client relationships; assists in new business productions; and represents Company with specified industry groups.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

QUALIFICATIONS

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

Experience
Ten (10) years of claims management, managed care and/or other related experience or equivalent combination of education and experience required to include three (3) years in a supervisory capacity in the specified field.

Skills & Knowledge

• In depth knowledge of 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

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental:  Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical:  Computer keyboarding, travel as required

Auditory/Visual:  Hearing, vision and talking

NOTE:  Credit Security Clearance, confirmed via a background credit check, is required for this position.

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 $100,000 - $120,000 per 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.

#LI-DV1

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.