Workers Compensation Director of Compliance, Hybrid
3 weeks ago
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- Provides primary leadership for Workers Compensation Compliance.
- Provides direction for and is responsible for the output of multiple disciplines within Compliance.
- Implements and ensures compliance with all state, federal, and state of jurisdiction laws and regulations pertaining to Workers Compensation, Auto and PIP, including remediation for findings of non-compliance.
- Serves as thought leader to workers compensation industry and associations to drive legislative and regulatory influence and promote visibility of myMatrixx.
- Provides regulatory interpretation and advice to internal/external stakeholders on workers compensation, operations, and products, as well as the impact of regulatory changes.
- Works closely with legal, government affairs, and finance to enable integration of company strategy and policy.
- Contributes to establishing strategic goals and execution oversight to achieve business revenue growth, operational efficiency, and regulatory compliance with long-term impact.
- Responsibilities include oversight of regulatory compliance, monitoring and influencing legislation, state fee schedules, state EDI reporting, WC PBM licensure and transparency reporting, client and industry communications, compliance practices, controls, audits and projects, and operations/financial reporting to senior leaders.
- Oversees the WC Compliance Senior Manager and Business Project Advisor for State EDI Reporting. Possesses significant freedom to act in the short term. Makes decisions, often based on limited information, that have a long-term impact across the function.
Essential Functions
- Contributes to establishing strategic goals and execution oversight to achieve revenue growth, operational efficiency and regulatory compliance with long-term impact.
- Develops innovative ways to leverage technology for automation and EDI processing to achieve operational efficiency and client satisfaction.
- Oversees the establishment of workers compensation, auto and PIP claim policies, practices and regulatory compliance.
- Provides oversight of BPO and 18 Claims manager/supervisor/analysts.
- Ensures that production levels and targets are achieved and effective processing controls are in place.
- Requires knowledge of state workers compensation regulations, fee schedules, state reporting requirements and prior authorization management.
Qualifications
- Bachelor's Degree and 10+ years of relevant experience
- Master's Degree preferred
- 5+ years of management experience
- Workers Compensation claims experience preferred
- Demonstrated initiative, independent thinker and worker.
- Excellent communication skills – both verbal and written.
- Advanced problem solving skills.
- Ability to work cross-functionally to define, scope, analyzes and resolves strategic issues.
- Willingness to share opinions and take risk.
- Demonstrated ability to prioritize and manage work load and meet project deadlines.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
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Tampa, Florida, United States Cigna Full timeJob DescriptionProvides primary leadership for Workers Compensation Compliance. Provides direction for and is responsible for the output of multiple disciplines within Compliance. Implements and ensures compliance with all state, federal, and state of jurisdiction laws and regulations pertaining to Workers Compensation, Auto and PIP, including remediation...
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