Claims Team Lead - Workers Compensation | Licensing and Jurisdiction: NV - Hybrid

Sedgwick•Las Vegas, NV

6d•Hybrid

About The Position

The Claims Team Lead supervises multiple teams of workers compensation examiners and technical staff. The role monitors workloads and claim activities, provides training and technical and jurisdictional direction on claims adjudication, and maintains diaries on team claims, including frequent diaries for complex or high-exposure claims. The lead also reviews claim quality and documentation, handles second-level appeals, reviews reserves on high-cost claims, monitors sensitive and litigated claims, and maintains client relationships. The position has a broad supervisory scope, including personnel administration, hiring, performance development, and coaching. It also supports the organization's quality programs and contributes to process improvement. Nevada licensing and jurisdiction knowledge are required. The role is hybrid.

Requirements

High school diploma or GED required.
Six years of claims experience, or an equivalent combination of education and experience.
Two years of claims supervisor experience.
Nevada licensing and jurisdiction knowledge required.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification applicable to the line of business.

Responsibilities

Supervise multiple teams of examiners, multiple product line examiners, and/or at least seven technical operations colleagues; delegate duties when appropriate.
Identify and advise management of trends, problems, and issues, recommend actions, and share ideas for continuous process improvement.
Coordinate office projects with management.
Provide technical and jurisdictional direction on examiner reports and claims adjudication.
Compile, review, and analyze management reports and take appropriate action.
Perform quality reviews of claims in accordance with audit requirements, service contract requirements, and quality standards.
Act as the second level of appeal for client and claimant issues and implement final appeal dispositions.
Review reserves on high-cost claims and claims exceeding individual examiner authority.
Monitor third-party claims and periodically review litigated, serious vocational rehabilitation, questionable, and client-designated sensitive claims.
Maintain client contact, promote professional client relationships, make recommendations based on claim status, and provide written claim summaries when requested.
Ensure direct reports are properly licensed in the jurisdictions served.
Ensure claims files are correctly coded and adequately documented by claims examiners.
Administer personnel policies and follow staffing standards and training recommendations.
Interview and hire colleagues, establish performance development plans, and conduct performance discussions.
Provide support, guidance, leadership, and motivation to promote colleague performance.
Support the organization's quality programs and perform other duties as assigned.