Workers Compensation Claims Team Lead | Dedicated Client | Jurisdictions: DE, IL, LA,MO,NJ,OK,TN, TX | License: Required

Sedgwick•Alley, MO

4d•Remote

About The Position

The Workers Compensation Claims Team Lead supervises multiple teams of workers compensation examiners and technical staff for client accounts. The role monitors workloads and individual claim activity, provides training and technical and jurisdictional guidance, and maintains a diary on team claims, including frequent diaries for complex or high-exposure claims. The position supports claims adjudication, quality assurance, client service, and continuous process improvement, while ensuring that claims files are properly coded and documented and that direct reports hold required jurisdictional licenses. The Team Lead reviews management reports and claim reserves, conducts quality reviews, serves as a second-level appeal contact for client and claimant issues, and maintains periodic oversight of litigated, serious rehabilitation, questionable, and sensitive claims. The role also maintains client relationships, makes recommendations based on claim status, and provides written claim summaries as requested. Supervisory duties include applying personnel policies, interviewing and hiring colleagues, setting performance development plans, conducting performance discussions, and providing leadership and guidance. The posting also describes the opportunity as involving complex workers compensation claims, supervisory responsibilities, client-facing solutions, professional development, and flexibility in daily work, location, and career path. The position requires a license and knowledge of the listed jurisdictions: DE, IL, LA, MO, NJ, OK, TN, and TX.

Requirements

Two years of claims experience or an equivalent combination of education and experience.
Required license; licenses must meet requirements for the jurisdictions served.
Jurisdiction knowledge: DE, IL, LA, MO, NJ, OK, TN, and TX.
Ability to think clearly and conceptually, exercise judgment and discretion, troubleshoot, solve problems, and analyze information.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Computer keyboarding ability; hearing, vision, and talking abilities.
Supervisory experience is not required.

Nice To Haves

Bachelor’s degree from an accredited college or university preferred.
Professional certifications 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 where appropriate.
Identify and advise management about trends, problems, and issues, recommend courses of action, communicate new procedures and process-improvement ideas, and coordinate office projects.
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 to meet audit, service-contract, and quality requirements.
Act as the second level of appeal for client and claimant issues involving claim-specific, procedural, or special requests, and implement the final disposition of appeals.
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 and professional 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 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.
Provide backup for the team lead when out of the office.
Analyze complex or technically difficult claims, determine benefits due, negotiate settlements, and identify subrogation opportunities, as described in the candidate overview.