Workers Compensation Director of Compliance, Hybrid
3 weeks ago
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.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
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.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
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