Workers Compensation Claims Team Lead | MD, VA, DC, WV, DE Jurisdictional Knowledge | WV & DE Licensing
About The Position
Workers Compensation Claims Team Lead | MD, VA, DC, WV, DE Jurisdictional Knowledge | WV & DE Licensing Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Apply your Workers Compensation & supervisory knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
Requirements
- 5 years of claims management experience or equivalent combination of education and experience required.
- High School Diploma or GED required.
- Jurisdiction Knowledge: MD, VA, DC, WV, DE
- Licensing: WV & DE
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
Responsibilities
- Supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients.
- Monitor colleagues' workloads, provide training, and monitor individual claim activities.
- Provide technical/jurisdictional direction to examiner reports on claims adjudication.
- Maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
- Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; 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.
- 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.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
- medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
