Performance Assurance Analyst

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE: The Quality Analyst assesses and reviews Sedgwick examiners against the claim management process, evaluates examiners’ actions against the established process and technical activities at a claim level, with a focus on identifying and interpreting trends in compliance by conducting targeted audits, and identifies areas of concern, recommending appropriate system enhancements and areas for additional or enhanced training.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Audits and holistically assesses the examiner versus the client files for accuracy and adherence to client guidelines using critical thinking and proprietary quality tools.
• Analyzes audit data to identify quality trends and proposes remediation activities for clients supported on caseload.
• Reviews audit data and presents monthly audit results to local, regional, and national management as requested.
• Assists Total Performance Manager in coordinating and implementing Sedgwick business unit (SBU) and national quality initiatives at the local and/or SBU level.
• Recommends training and improvement activities needed to meet established operational and technical audit requirements based on audit review findings.
• Facilitates regular partnership meetings with operational teams to discuss trends and validate examiner counts to ensure appropriate number of audits are completed in a timely manner.
• Partners with team members when heavy audit volumes occur by assisting with caseloads/clients outside of normal scope.
• Verifies examiner counts with operations to maintain appropriate audit counts.

• Documents and reviews findings in accordance with team processes.
• Responsible for both individual and organizational audit volume completion.
  • Stays current on technical claims, compliance, and jurisdictional expertise.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Supports Quality projects as assigned by leadership.
• Performs other duties as assigned.
• Travels as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification (i.e. AIC, CPCU, ARM, CPDM, SHRM, Lean or Six Sigma) preferred.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include three (3) years of claims management experience at an advanced technical level. Knowledge with Two (2) or more lines of business (EX: FMLA, Unpaid Leave, Disability, Statutory, Accommodation etc.) preferred.

Skills & Knowledge

• Knowledge of ERISA, FMLA and statutory regulations
• Knowledge of claims handling and file review practices and procedures
• Versed in quality and auditing processes
• Excellent oral and written communication skills, including presentation skills
• Proficient in Microsoft Excel including maintaining data and utilizing basic functions.
• PC literate, including Microsoft Office products and digital resources
• Analytical and interpretive skills
• Strong organizational skills
• Ability to learn how to navigate virtual meeting, screen sharing, and collaboration applications
• Self-motivated with an ability to thrive in a remote work environment
• Excellent interpersonal skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• 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

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 $65,000 - $69,000 annual salary. 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.