SVP Bill Review- Careworks

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 OF THE ROLE: To plan, direct, control and oversee functions within Bill Review-Careworks; and to maintain relationships with internal and external customers, the provider/network and other members of the vendor community.

ESSTENTIAL RESPONSIBLITIES

• Designs, develops, and implements cost effective strategies promoting productive outcomes for Bill Review operations.
• Ensures quality performance of the bill review product to customers through monitoring the department quality outcomes.
• Creates and operates within the financial budget for operations units.
• Partners with key management team members from other corporate divisions to determine best practices, provide smooth interaction, and promote teamwork.
• Represents the company externally on bill review issues.
• Analyzes reporting tools allowing for strong oversight and controls.
• Analyzes organizational needs; determines any changes or updates to structure and staffing models.
• Establishes business plan with goals and objectives for offices/locations within assigned area.
• Establishes policy and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements.
• Partners with internal resources to direct the management of vendor performance.
• Performs other duties as assigned.
• 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.

• Plans for staffing needs, including succession, bench-strength, and new business.

QUALIFICATIONS

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

Ten (10) years of experience and proficiency with workers' compensation legal and regulatory requirements and/or quality/managed care concepts, and experience with Auto PIP 1st and 3rd party billing processes. Experience to include: seven (7) years of strong management or equivalent combination of education and experience required. Six (6) years of experience managing bill review preferred.

SKILLS & KNOWLEDGE

• Thorough knowledge of managed care processes and procedures
• Thorough knowledge of state laws and regulations
• Ability to oversee executive level client/account management and support
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Exceptional leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational and time management skills
• Excellent interpersonal skills
• Ability to delegate responsibilities and duties
• Ability to establish credibility and be decisive
• Ability to meet or exceed Performance Competencies

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.

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 $165,462.00 - $200,000.00 annually. 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-LM1 #LM-REMOTE #WORKERSCOMPENSATION #SVP #BILLREVIEW

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.