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Claims Team Lead - Workers Compensation

Recruiting Only - Telecommuter, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Itā€™s an opportunity to do something meaningful, each and every day. Itā€™s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if youā€™re someone who cares, thereā€™s a place for you here. Join us and contribute to Sedgwick being a great place to work.


Great Place to WorkĀ®
Most Loved WorkplaceĀ® 
Forbes Best-in-State Employer

Claims Team Lead - Workers Compensation

PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES 

  • 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.
  • 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 ā€¦
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