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National Manager - ERISA Compliance & Disability Benefit Appeals CLAIM YOUR FUTURE AS A GREAT PERFORMER! Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and 'Claim Your Future.' PRIMARY PURPOSE: To be responsible for the technical and operational functions within assigned office(s) ensuring compliance with company standards and industry best practices; to ensure continuous quality improvement measures through appeal result analysis; to determine management strategies related to client service plans; to be responsible for staffing and training needs; and to be responsible for budget preparation and profit & loss management. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Responsible for operations management for assigned programs/offices. Establishes policy and procedure to ensure compliance to best practices, claim management service standards, ERISA regulations and client service requirements. Monitors changes to ERISA legislation; incorporates workflow changes into the process as defined in legislative changes. Establishes business plan with goals and objectives for partnership with assigned locations/offices. Ensures effective process management; ensures accuracy of final customer deliverables resulting in reduction of errors, increased productivity and customer satisfaction. Facilitates the reduction or process barriers, technology constraints, or resource constraints by directing and influencing the activities of other internal departments (i.e. IT, operations and business development). Works with program managers to resolve all major customer service issues regarding the appeal administration process. Assists program managers in educating the client on appeals data-drivers of cost impacting assigned programs. Coordinates project activities; acts as primary contact for the national Appeals team for clients and internal customers with focus on maintaining and improving overall customer satisfaction. Identifies issues that impact customer satisfaction and works with program managers to get issues resolved as it relates to the appeals unit. Gathers, prepares and monitors operations and financial statistical data for reporting provided to the client. Assists in coordination of sales and client service efforts. Ensures compliance with all applicable quality initiatives.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the total performance management initiative. Travels as needed.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred.
Experience
Ten (10) years insurance industry experience required to include two (2) years auditing experience and two (2) years supervisory experience. Experience in management and short-term and long-term disability claims management preferred. MS/MA degree may substitute for three (3) years of required experience; BS/BA degree may substitute for two (2) years of required experience.
Skills & Knowledge Strong knowledge of disability claims management practices Knowledge of ERISA regulations Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytical and interpretive skills In-depth knowledge of client servicing Excellent interpersonal skills Strong organizational skills Excellent negotiation and facilitation skills Ability to handle conflict and confront challenging issues in a fast-paced work environment 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.
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 CMS is an Equal Opportunity Employer and a Drug-Free Workplace
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