Claims Team Lead - Workers Compensation | Licensing and Jurisdiction: NV - 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 guidance on claim adjudication, and maintains claim diaries, particularly for complex or high-exposure claims. The position also supports quality programs, client relationships, appeals, reserve reviews, and appropriate handling and documentation of claims. The role administers personnel policies, participates in hiring, sets performance development plans, conducts performance discussions, and provides leadership and guidance to promote colleague performance. Nevada licensing and jurisdiction knowledge are required. The position is hybrid.
Requirements
- High school diploma or GED.
- Six years of claims experience, or an equivalent combination of education and experience.
- Two years of claims supervisor experience.
- Required Nevada licensing and jurisdiction knowledge.
- Ability to think clearly and conceptually and demonstrate sound judgment, troubleshooting, problem-solving, analytical, and discretionary skills.
- Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
- Ability to perform computer keyboarding; travel as 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 courses of action, communicate process-improvement ideas, and coordinate office projects.
- Provide technical and jurisdictional direction on claims adjudication.
- Compile, review, and analyze management reports and take appropriate action.
- Conduct claim quality reviews in compliance with audit requirements, service contracts, and quality standards.
- Serve as the second level of appeal for client and claimant issues involving claim-specific, procedural, 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, recommend actions based on claim status, and provide written claim summaries when requested.
- Ensure direct reports are properly licensed in the jurisdictions served.
- Ensure claim files are correctly coded and adequately documented by 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 maximum performance.
- Perform other duties as assigned and support the organization's quality programs.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision benefits.
- 401(k) benefits available on day one.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
