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Quality Team Lead - Workforce Absence

PRIMARY PURPOSE:  Supervises Performance Assurance  Analysts and Total Performance Coaches on audit process and monitors colleagues' workloads including accuracy and production.  The Quality Team Lead supports and develops colleagues, identifies, and manages needed training, and monitors individual claim activities for trends and improvements; provides guidance and support in identifying areas of emphasis for deeper analysis.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Provides support, feedback, and guidance concerning daily operations and audit activity to the Quality team.Identifies and advises management of trends, problems, and issues, as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and supports other quality initiatives as directed by Quality leadership.Assigns and checks work product for direct reports ensuring steady workflow, accuracy and productivity; assures that direct reports are properly trained.Provides technical/procedural direction to auditors during their day-to-day auditing related to best practice, compliance and client policies. Provides guidance on questions from auditors, reviews claim audit information to determine if findings occurred and advises on prioritization and caseload management.Compiles reviews and analyzes management reports; takes appropriate action based on data.Performs internal quality reviews on audits in compliance with audit requirements, standards, and service contract requirements.Maintains contact with operations teams on claims and promotes a professional relationship; makes recommendations to operations as suggested by the audit results.Ensures claims files are coded correctly, and adequate documentation is made by examiners during the audit process.Identifies areas to minimize risk of fines, penalties, errors, and omissions and makes recommendations for improvements.Engages direct reports in discussing and supporting goals for growth, monitors productivity and quality goal progress, and ensures that the team is meeting service and productivity standards and resolving operation issues. Ensures team follows established processes and operating procedures.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.Travels as required.

SUPERVISORY RESPONSIBILITIES

Provides support, guidance, leadership and motivation to promote maximum performance for two or more colleagues.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.

QUALIFICATIONS

Education & Licensing

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

Experience

Six (6) 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, and two (2) years’ experience in Quality Auditing. Knowledge with three (3) or more lines of business (EX: FMLA, Unpaid Leave, Disability, Statutory, Accommodation etc.) preferred.

Skills & Knowledge

Strong knowledge of ERISA, FMLA and Statutory regulationsThorough knowledge of claims processes for multiple lines of businessAbility to work independently and with autonomyAbility to solve difficult and complex problems based on analysis, experience, and judgementExcellent oral and written communication skills, including presentation skillsPC literate, including Microsoft Office products with intermediate Excel skillsAnalytical and interpretive skillsStrong organizational skillsExcellent interpersonal skillsAbility to create and complete comprehensive, accurate and constructive reportsAbility to work in a team environmentAbility 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

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.