Director of Regulatory Compliance

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

Director of Regulatory Compliance

PRIMARY PURPOSE: To direct delivery of current and applicable information on state and federal regulations impacting operational activity; to direct compliance, training, and response with appropriate internal and external stakeholders.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Develops compliance organizational strategies and establishes functional objectives in line with organizational objectives.
• Monitors federal, state and local statutes and regulations to identify modifications which impact operations processes.
• Protects assets by establishing and monitoring compliance standards, anticipating emerging compliance trends and designing improvements to internal control structure.
• Oversees response to state inquiries, complaints, or grievances regarding operational issues.
• Determines and documents course of action to comply with changes within operations.
• Directs research to respond to operational needs and inquiries.
• Directs the process to gain state certifications and/or re-certifications in regard to operational processes (i.e. utilization review and other services including URAC).
• Represents company with regulatory and industry organizations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred. Paralegal certification strongly preferred.

Experience
Ten (10) years of related experience or equivalent combination of education and experience required to include seven (7) years of experience in compliance, governmental relations, regulatory or similar function. Corporate legal department and insurance industry experience preferred.

Skills & Knowledge

• Strong knowledge of healthcare delivery
• Working knowledge of the insurance industry and claims administration
• Extensive knowledge of workers' compensation and managed care programs with specific or related experience in the legislation, regulations, and compliance affecting those areas
• 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
• Excellent judgment and discretion
• Excellent troubleshooting and problem solving skills
• Ability to handle work-related stress
• Ability to handle multiple priorities simultaneously and meet deadlines
• 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:  Compu