Claims Team Lead - Workers Compensation

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.

We're looking for a driven Claims Team Lead - Workers Compensation to supervise multiple teams of examiners and technical staff for workers compensation claims. As a Claims Team Lead, you will deliver innovative customer-facing solutions to clients, leverage Sedgwick's broad global network of experts, and take advantage of various professional development opportunities.

Primary Purpose of the Role To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.

Essential Responsibilities May Include

• Supervise multiple teams of examiners, multiple product line examiners and/or several technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
• Identify and advise management of trends, problems, and issues as well as recommended course of action; inform management of new procedures and ideas for continuous process improvement; and coordinate with management projects for the office.
• Provide technical/jurisdictional direction to examiner reports on claims adjudication.
• Compile, review, and analyze management reports and take appropriate action.
• Perform quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
• Act as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implement final disposition of the appeal.
• Review reserve amounts on high-cost claims and claims over the authority of the individual examiner.
• Monitor third-party claims; maintain periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims, and sensitive claims as determined by the client.
• Maintain contact with the client on claims and promote a professional client relationship; make recommendations to the client as suggested by the claim status; and provide written resumes of specific claims as requested by the client.
• Assure that direct reports are properly licensed in the jurisdictions serviced.
• Ensure claims files are coded correctly and adequate documentation is made by claims examiners.
• Perform other duties as assigned.
• Support the organization's quality program(s).

Supervisory Responsibilities

• Administer company personnel policies in all areas and follow company staffing standards and training recommendations.
• Interview, hire, and establish colleague performance development plans; conduct colleague performance discussions.
• Provide support, guidance, leadership, and motivation to promote maximum performance.

Qualifications

• Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
• Experience: Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
• Licensing / Jurisdiction Knowledge: NV REQUIRED

Taking Care of You

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.