Workers Compensation Claims Team Lead | Hybrid or Remote | Brea, CA
About The Position
This role is for a Workers Compensation Claims Team Lead at Sedgwick, a company focused on providing meaningful support to individuals facing unexpected challenges. The company emphasizes career growth, a caring culture, and work-life balance. Sedgwick has been recognized by Newsweek, Certified as a Great Place to Work®, and by Fortune. The ideal candidate will be a proven leader with expertise in California workers' compensation claims, experience in developing high-performing teams, strong technical knowledge, and the ability to guide complex and high-exposure matters. The position can be based in Brea, CA (Hybrid) or Remote for candidates located 25+ miles from a Sedgwick office.
Requirements
- Six (6) years of California workers compensation claims management experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
- California jurisdictional knowledge required.
- SIP certification required or must be obtained within one (1) year of hire date.
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certifications as applicable to line of business preferred.
Responsibilities
- Supervises a team of workers compensation claims examiners and technical staff; may delegate some duties to others within the unit.
- Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
- Provides technical/jurisdictional direction to examiner reports on claims adjudication.
- Compiles reviews and analyzes management reports and takes appropriate action.
- Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
- Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
- Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
- Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
- Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
- Assures that direct reports are properly licensed in the jurisdictions serviced.
- Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
- Provides support, guidance, leadership and motivation to promote maximum performance.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical insurance
- Dental insurance
- Vision insurance
- 401K on day one
- 401K matching
- PTO
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
