Claims Team Lead – Workers Compensation
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Job Description
Workers compensation claims team lead supervising examiner teams and claim adjudication for Sedgwick, a global claims management company. Providing California jurisdictional direction, quality oversight, and client support.
Responsibilities:
- Supervise multiple teams of workers compensation examiners and technical staff
- Monitor colleagues' workloads and individual claim activities
- Provide training and technical/jurisdictional direction on claims adjudication
- Maintain diaries on claims, including complex or high exposure claims
- Identify trends, problems, and issues and advise management on recommended actions
- Coordinate management projects and continuous process improvement initiatives
- Compile, review, and analyze management reports
- Perform quality reviews on claims in compliance with audit, service contract, and quality standards
- Act as second level of appeal for client and claimant issues and implement final dispositions
- Review reserve amounts on high cost claims and claims over examiner authority
- Monitor third party, litigated, serious vocational rehabilitation, questionable, and sensitive claims
- Maintain client contact, promote professional client relationships, and make claim-status recommendations
- Provide written claim summaries to clients as requested
- Ensure claims files are correctly coded and adequately documented
- Administer company personnel policies and staffing standards
- Interview, hire, and establish colleague performance development plans
- Conduct colleague performance discussions and provide leadership, guidance, and motivation
- Support the organization's quality programs
Requirements:
- High School Diploma or GED required
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Six (6) years of claims experience or equivalent combination of education and experience required
- Two (2) years of claims supervisor experience required
- CA licensing/jurisdiction knowledge
- Direct reports must be properly licensed in the jurisdictions serviced
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress
- Ability to handle multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Travel as required
Benefits:
- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, and vision benefits
- 401K on day one
- Work-life balance
- Professional development opportunities
- Flexibility and autonomy in daily work, location, and career path
- Diverse and comprehensive benefits supporting mental, physical, financial, and professional needs
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