Workers Compensation Claims Team Lead | Hybrid or Remote | Brea, CA

Sedgwick • Brea, CA

6d • Hybrid

About The Position

Sedgwick is seeking a proven leader with California workers' compensation claims expertise who thrives in a fast-paced environment and enjoys developing high-performing teams. The ideal candidate brings strong technical knowledge of California workers' compensation claims, experience supervising claims examiners and support staff, and the ability to provide guidance on complex and high-exposure matters. This position can be based in Brea, CA (Hybrid) or Remote for candidates located 25+ miles from a Sedgwick office. The primary purpose of this role is to supervise the operation of a team of workers compensation claims examiners and technical staff, monitor workloads, provide training, and monitor individual claim activities. The role also involves providing technical/jurisdictional direction on claims adjudication and maintaining diaries on complex or high exposure claims.

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.
• Licenses as required.
• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree