Workers Compensation Compliance Specialist

Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of more than 14,000 colleagues in some 275 offices located in the U.S., Canada, the U.K and Ireland.

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. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Creates and maintains relationships with state regulators in order to further our 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). - May act 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 claims 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 in independently or in a team environment - Ability to meet or exceed Performance Competencies 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