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. Itās an opportunity to do something meaningful, each and every day. Itās 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 youāre someone who cares, thereās a place for you here. Join us and contribute to Sedgwick being a great place to work.
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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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Telecommuter
Benefits/Perks401k and matching Career growth Comprehensive benefits Comprehensive benefits package Dental Disability Employee assistance Flexibility Flexible Spending Health savings account Inclusive environment Life Insurance Medical PTO Support for mental and physical needs Vision Voluntary benefits
Tasks- Analyze reports
- Client communication
- Manage claims
- Monitor workloads
- Provide training
- Quality review
- Supervise teams
- Travel as required
Adjudication Analysis Analytical Claims Adjudication Claims management Client Relations Communication Compliance Data analysis Disability Discretion Documentation Flexibility Insurance Interpersonal Interpretive IT Judgment Keyboarding Leadership Management Microsoft Office Microsoft Office products Motivational Negotiation Organizational PC literate Performance competencies Performance development Presentation Process Improvement Quality Assurance Quality review Rehabilitation Staffing Supervisory Team Leadership Technical Direction Training Troubleshooting Workers Compensation Written communication
Experience5 years
EducationBachelor's degree Equivalent Health
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9