Claims Team Lead - Workers Compensation

Sedgwick

3d•$72,914 - $100,000•Onsite

About The Position

This role supervises the operation of multiple teams of examiners and technical staff for workers compensation for clients. The position involves monitoring colleagues' workloads, providing training, and overseeing individual claim activities. It also includes providing technical/jurisdictional direction to examiner reports on claims adjudication and maintaining a diary on claims within the teams, with frequent diaries on complex or high exposure claims. Sedgwick is a global leader in risk and claims administration, helping clients navigate the unexpected with expertise and advanced AI-enabled technology.

Requirements

Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
Thorough knowledge of claims management processes and procedures for multiple product lines
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
Credit security clearance, confirmed via a background credit check, is required for this position.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.
Licenses as required.
Professional certifications as applicable to line of business preferred

Responsibilities

Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
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 coordinates with management projects for the office.
Provides technical/jurisdictional direction to examiner reports on claims adjudication.
Compiles reviews and analyzes management reports and takes appropriate action.
Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
Assures that direct reports are properly licensed in the jurisdictions serviced.
Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
Supports the organization's quality program(s).