Job Description

Workers Compensation Client Performance Manager | Dedicated Client | Remote

PRIMARY PURPOSE: To be responsible for the quality aspects of a specific client including client service instructions and reserves; to conduct client specific audits; to monitor client audit compliance; to resolve client issues by working with the company Quality and Operations staff.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

1. Ensures adherence to client service instructions.
2. Monitors client reserves for accurate reflection of client's book of claims; ensures reserves are within an appropriate range.
3. Tracks and trends performance guarantee and gain share agreements at the client level.
4. Ensures client's claims reports are properly and timely prepared and distributed.
5. Monitors client's average cost of claims; identifies trends and excessive cost factors.
6. Conducts client specific operational audits; monitors client audit compliance.
7. Works with company Quality and Operations staff to resolve client issues including results of client Compass audits.
8. Manages client specific internal control report issues.
9. Ensures timely payment of TTD, medical and vendor bills; ensures appropriate vendor utilization.
10. Reviews aging claims for file closure ensuring claims do not age beyond appropriate time frames.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES:

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

QUALIFICATIONS:

Education & Licensing:

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

Experience:

Eight (8) years of related experience or equivalent combination of education and experience required to include five (5) years of claims management and two (2) years of auditing experience. One (1) year of continuous service with the company is preferred.

Skills & Knowledge:

1. Thorough knowledge of claims management practices and procedures.
2. Excellent oral and written communication, including presentation skills.
3. PC literate, including Microsoft Office products.
4. Leadership/management/motivational skills.
5. Analytical and interpretive skills.
6. Strong organizational skills.
7. Excellent interpersonal skills.
8. Ability to work in a team environment.
9. 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.

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.

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