Bill Review Team Lead

Columbus, OH, United States

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.

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Bill Review Team Lead

PRIMARY PURPOSE : To supervise expense bill reviewers in needs assessment and implementation of timely cost-effective fee management services in compliance with corporate/jurisdictional standards; to provide review of technical, complex claims requiring extensive skills/experience; and to interact with expense bill reviewers, utilization review nurses, and claims staff to resolve problems and/or implement and improve workflow and communication.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Performs senior position duties, including one or more of the following: train expense bill reviewers; organize and assign workload; monitor performance; manage performance reviews; and assist with complex bill reviews.

Reviews and maintains standards of turnaround expectation, customer satisfaction expectations.

Works directly with reviewers to assure effective results through skilled, efficient services.

Maintains knowledge and familiarity with corporate quality standards; ensures consistent application.

Assures maintenance of productivity standards within acceptable error rate.

Reviews bills using experience-gained knowledge of fee schedule and medical terminology; maintains knowledge of all bills regardless of complexity of claims, levels of service, or multiple jurisdictions.

Ensures good results to our customers; provides quality customer service in oral and/or written communication.

Develops and maintains tracking and quality assurance reports; obtains and reviews operational reports; and develops and implements operational revisions as necessary to improve service or unit efficiency.

Acts as liaison between claims staff, nursing staff, medical bill payment team, and expense bill reviewers.

Responds to written or verbal requests from vendors, insurance carriers, legal representatives, and injured workers by preparing documentation; may assist in preparing case testimony.

Assists in maintaining customer relationships from a technical perspective; assists sales process/customer tours as necessary.

Works with program manager, claims unit, expense bill reviewers to resolve questions, redesign workflow, and ensure efficient, accurate bills processing.

Participates in group meetings and training sessions.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

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.

Experience

Six (6) years of experience in workers compensation claims processes with experience in state regulatory issues for payment of expense bills or equivalent combination of education and experience required.

Skills & Knowledge

Knowledge of legislative environment and the market place

Good customer service skills

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Leadership/management/motivational skills

Analytical and interpretive skills

Strong organizational skills

Excellent interpersonal skills

Excellent negotiation skills

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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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 $55,000 - $75,000 . 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.

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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)