Claims Team Lead - Workers Compensation | Jurisdiction: Southeast States | Licensing: FL or Home State Required - Remote

Sedgwick

9d•$67,000 - $85,000•Remote

About The Position

This role is for a Claims Team Lead specializing in Workers Compensation for clients in the Southeast States. The position requires a FL or Home State license and is remote. The ideal candidate will embody Sedgwick's caring counts model and core values, including empathy, accountability, collaboration, growth, and inclusion. The primary purpose of the role is to supervise multiple teams of examiners and technical staff, monitor workloads, provide training, oversee individual claim activities, offer technical/jurisdictional direction on claims adjudication, and maintain diaries on complex or high exposure claims.

Requirements

High School Diploma or GED required.
Six (6) years of claims experience or equivalent combination of education and experience required.
Two (2) years claims supervisor experience required.
FL or Home State license required.
Knowledge of FL, AL, AK, GA, Mississippi, TN, SC, NC jurisdictions.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.
Professional certification 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.
Performs other duties as assigned.
Supports the organization's quality program(s).
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.
Provides support, guidance, leadership and motivation to promote maximum performance.