SIU Lead occupation at Sedgwick CMS in SeaTac

Sedgwick CMS is in need of SIU Lead on Tue, 19 Nov 2013 07:02:20 GMT. Special Investiation Unit Lead CLAIM YOUR FUTURE AS A GREAT PERFORMER! Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the...

SIU Lead

Location: SeaTac, Washington

Description: Sedgwick CMS is in need of SIU Lead right now, this occupation will be presented in Washington. Further informations about this occupation opportunity kindly see the descriptions. Special Investiation Unit Lead
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its co! lleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, 'Claim Your Future.'
PRIMARY PURPOSE: To review incoming referrals and provide investigative action plan; to review claims investigation results and communicate findings to internal and external clients and stakeholders; to provide consulting services for the recommendation of additional investigations and/or referral to Fraud & Compliance; to measure effectiveness of data searches and make recommendations for new sources; and to provide training to claims team.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Reviews incoming referrals and provides investigative actio! n plan.
• Analyzes claims investigation results for fraud indicators and communicates findings to internal and external stakeholders; generates invoice for services rendered.
• Provides consulting services for the recommendation of additional investigations and/or referral to Fraud & Compliance.
• Establishes relationships with vendor partners to ensure vendor compliance and quality.
• Reviews vendor reports to identify trends and areas of opportunity for increased service efficiency and quality

ESSENTIAL FUNCTIONS and RESPONSIBILITIES- Boeing Specific

• Initiate surveillance assignments
• Review/evaluate background checks
• Coordinate surveillance assignments / reports with defense counsel
• Direct investigation assignments to internal or external panel vendors
• Manage / enforce investigation panel firm performance
• Audit / authorize payment of investigation panel firm bills
• Tra! ck assignments and implement an organized approach to sustained investigation efforts to produce results
• Communicate investigation results with defense counsel, Boeing Workers' Compensation Administrator, and others as appropriate to strategize further activities
• Establish and maintain close working relationship with state fraud adjudicator
• Establish and maintain direct contacts with prosecuting attorneys for criminal proceedings

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.

Supports the organization's quality program(s).

T ravels as required.

Occasional on site field investigations

Trial appearances as necessary QUALIFICATIONS
Education & Licensing

Baccalaureate degree from an accredited college or university preferred.
Experience

Six (6) years of Workers' Compensation insurance industry experience or equivalent combination of education and! experience required.
Skills & Knowledge
Analytical and interpr! etive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation skills Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Ability to work in a team environment Ability to meet or exceed Performance Competencies Good working knowledge of worker's compensation investigation 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. 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

N/A
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If you were eligible to this occupation, please deliver us your resume, with salary requirements and a resume to Sedgwick CMS.

Interested on this occupation, just click on the Apply button, you will be redirected to the official website

This occupation will be opened on: Tue, 19 Nov 2013 07:02:20 GMT

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