Claims Team Lead - Workers Compensation | Jurisdiction & Licensing: NV Required
About The Position
The Claims Team Lead supervises multiple teams of workers’ compensation examiners and technical staff serving clients. 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. It also supports quality programs, client relationships, operational improvement, and the professional development and performance of direct reports. The role requires Nevada jurisdiction knowledge and licensing. A high school diploma or GED is required; a bachelor’s degree and applicable professional certification are preferred. Candidates must have six years of claims experience, or an equivalent combination of education and experience, including two years of claims supervisor experience.
Requirements
- High school diploma or GED required.
- Six years of claims experience, or an equivalent combination of education and experience, including two years of claims supervisor experience.
- Nevada jurisdiction knowledge and licensing required.
- Ability to think clearly and conceptually and demonstrate excellent judgment, troubleshooting, problem-solving, analysis, and discretion.
- Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
- Ability to perform computer keyboarding and travel as required.
- Ability to hear, see, and speak.
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certification applicable to the line of business preferred.
Responsibilities
- Supervise multiple teams of examiners, multiple product-line examiners, and/or at least seven technical operations colleagues; delegate duties as appropriate.
- Identify and advise management about trends, problems, and issues, recommend courses of action, share ideas for process improvement, and 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.
- Conduct quality reviews of claims in accordance with audit requirements, service contract requirements, and quality standards.
- Serve as the second level of appeal for client and claimant issues involving specific claims, procedures, or special requests, 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 company 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.
- Perform other duties as assigned.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision coverage.
- 401(k) and matching.
- Paid time off (PTO).
- Disability and life insurance.
- Employee assistance program.
- Flexible spending account or health savings account.
- Additional voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
