Team Lead Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required

Sedgwick•Eden Prairie, AL

4d•Remote

About The Position

Sedgwick is seeking a remote Team Lead Claims Adjuster to lead workers’ compensation claims operations and adjudicate complex customer claims. The role applies claims and leadership expertise to deliver customer-facing solutions for clients across many industries, within a culture emphasizing empathy, accountability, collaboration, growth, and inclusion. The position supervises multiple teams of examiners, multiple product-line examiners, and/or at least seven technical operations colleagues. It provides technical and jurisdictional direction, oversees claim quality and documentation, reviews high-cost claims and reserves, and supports client and claimant appeals. The role also maintains client relationships, monitors sensitive and litigated claims, and ensures direct reports hold required licenses in the jurisdictions served. The role requires six years of claims experience, including two years of claims supervisor experience, or an equivalent combination of education and experience. A bachelor’s degree and applicable professional certifications are preferred; licenses are required. The position is remote and offers a flexible work schedule and career development opportunities.

Requirements

Six years of claims experience, or an equivalent combination of education and experience, including two years of claims supervisor experience.
Licenses as required for the jurisdictions served.
Ability to think clearly and conceptually and exercise 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 to hear, see, and talk.

Nice To Haves

Bachelor’s degree from an accredited college or university.
Professional certifications 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 as appropriate.
Identify and advise management of trends, problems, and issues, recommend courses of action, share ideas for continuous process improvement, and coordinate office projects.
Provide technical and jurisdictional direction to examiners on 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.
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 that exceed an individual examiner’s authority.
Monitor third-party claims and periodically review litigated, serious vocational rehabilitation, questionable, and client-identified sensitive claims.
Maintain client contact and professional relationships, make recommendations based on claim status, and provide written claim summaries as requested.
Ensure direct reports are properly licensed in the jurisdictions served.
Ensure claims files are coded correctly and contain adequate examiner documentation.
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.