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

Sedgwick•Eden Prairie, AL

5d•$69,000 - $97,000•Remote

About The Position

Sedgwick is seeking a Team Lead Claims Adjuster for workers’ compensation claims. This remote role applies claims-adjusting and leadership expertise to adjudicate complex customer claims and provide technical and jurisdictional direction to claims examiners. The role supervises multiple teams or groups of technical operations colleagues, supports quality and continuous improvement, and maintains professional relationships with clients. The Team Lead oversees claim reviews and appeals, monitors sensitive and litigated claims, reviews reserves on high-cost claims, and ensures claim files are accurately coded and documented. The position also carries people-management responsibilities, including staffing, training, performance development, and colleague guidance. The posting identifies Texas, Minnesota, and Michigan in its title and Texas, Minnesota, and Utah in its work-location section; it states that licensing is required and specifies a Texas or home-state license in the title.

Requirements

Six years of claims experience, or an equivalent combination of education and experience.
Two years of claims supervisor experience.
Required licenses for the applicable jurisdictions; the title specifies a Texas or home-state license.
Ability to think clearly and conceptually and exercise sound 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 speak.

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 when appropriate.
Identify and advise management about trends, problems, and issues, recommend courses of action, share ideas for continuous process improvement, and coordinate office projects.
Provide technical and jurisdictional direction to examiner reports on claims adjudication.
Compile, review, and analyze management reports and take appropriate action.
Perform quality reviews of claims in compliance with audit requirements, service contract requirements, and quality standards.
Act as the second level of appeal for client and claimant issues concerning claims, procedures, or special requests, and implement the final appeal disposition.
Review reserves on high-cost claims and claims exceeding an individual examiner's 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 hold the licenses required for 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.
Perform other assigned duties and support the organization's quality programs.