(Remote) Claims Compliance Manager - Workers Compensation | Maine Jurisdiction

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

PRIMARY PURPOSE: To ensure the company's regulatory standards compliance; to manage state regulatory violations by tracking, responding and disputing; and to ensure good relationships with state regulators.

GEOGRAPHIC LOCATION
Candidates may work remotely from any state as long as they are experienced in the Maine workers compensation jurisdiction.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Creates and maintains relationships with state regulators in order to further our reputation and standing with the state.
• Maintains working knowledge of state regulatory system; keeps abreast of state regulatory changes and enhancements.
• Develops and provides reporting on penalty and compliance issues throughout the state.
• Identifies, develops and assists in delivering any colleague training on state system compliance issues or enhancements to the current systems.
• Identifies and requests appropriate claims management system enhancements to improve compliance.
• Acts as primary liaison between company and carrier partners on specific issues of penalties within jurisdiction.
• Manages violation reports; responds to violation notices; manages disputes within jurisdiction; and files official protests with the DOAH (Department of Administrative Hearings).
• Assists in delivery of focused jurisdictional compliance training.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS

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

Experience
Six (6) years of related experience or equivalent combination of education and experience required to include five (5) years of compliance experience and three (3) years of claims management, managed care, call center or related experience.

• Jurisdictional knowledge of Maine Workers Compensation required.

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
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

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 ( 75,313.00 - 90,000). 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.

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.