Claims Team Lead - Workers Compensation | Brea, CA
About The Position
The Claims Team Lead oversees a team of examiners and technical staff handling workers’ compensation claims for a dedicated client. The role manages workloads, provides training, monitors individual claim activity, and offers technical and jurisdictional guidance on claims adjudication. The lead maintains regular diaries, particularly for complex or high-exposure cases, supports quality reviews and reserve evaluations, and serves as a second-level appeal authority for client and claimant issues. This position is based in Brea, California, with a hybrid schedule of two days in the office and three days remote.
Requirements
- High school diploma or GED required.
- California workers’ compensation claim-handling experience required.
- Six years of claims experience or an equivalent combination of education and experience preferred.
- Professional certification as applicable to the line of business preferred.
- Clear and conceptual thinking, sound judgment, troubleshooting, problem-solving, analysis, and discretion.
- Ability to handle work-related stress, manage multiple priorities, and meet deadlines.
- Ability to travel as required.
Nice To Haves
- Bachelor’s degree from an accredited college or university preferred.
- Professional certification as applicable to the line of business preferred.
- Six years of claims experience or an equivalent combination of education and experience preferred.
Responsibilities
- Supervise examiners and technical operations colleagues, delegate duties, and ensure proper licensing and documentation standards.
- Provide technical and jurisdictional claims-adjudication guidance, including quality reviews and reserve evaluations for high-cost or complex claims.
- Act as a second-level appeal authority for client and claimant issues and implement final decisions.
- Identify trends, issues, and process-improvement opportunities; advise management and coordinate related projects.
- Monitor third-party and sensitive claims, including litigated and vocational rehabilitation cases.
- Maintain professional client relationships and provide recommendations and written summaries as needed.
- Ensure examiners accurately code and document claims.
- Manage team workloads, provide training, and monitor individual claim activities.
- Maintain regular diaries, especially for complex or high-exposure cases.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision benefits.
- 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
Mid Level
Education Level
High school or GED
