Workers Compensation Claims Team Lead | NY Jurisdiction experience | NY Licensing
About The Position
The Workers Compensation Claims Team Lead supervises multiple teams of workers’ compensation examiners and technical staff, overseeing claim adjudication, colleague workloads, training, and individual claim activity. The role provides technical and jurisdictional guidance, maintains oversight of claims—including complex and high-exposure claims—and supports quality, compliance, client service, and operational improvement. It also carries supervisory responsibilities for staffing, colleague development, performance discussions, and leadership. The position requires New York jurisdiction knowledge and licensing.
Requirements
- Ten years of claims experience, or an equivalent combination of education and experience, including two years of claims supervisor experience.
- New York jurisdiction knowledge.
- New York licensing; licenses as required.
- Ability to think clearly and conceptually and demonstrate excellent judgment, troubleshooting, problem-solving, analytical skills, and discretion.
- Ability to handle work-related stress and multiple priorities simultaneously, and meet deadlines.
- Computer keyboarding ability; hearing, vision, and talking abilities.
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 as appropriate.
- Identify and advise management about trends, problems, and issues, recommend actions, 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.
- Serve as the second level of appeal for client and claimant issues 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 sensitive claims as determined by the client.
- Maintain client contact, support professional client relationships, recommend actions based on claim status, and prepare written claim summaries when requested.
- Ensure direct reports hold required licenses in the jurisdictions served.
- Ensure claims files are coded correctly and adequately documented by examiners.
- Administer 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.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision coverage.
- 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
Manager
