Claims Team Lead: Adjudication, QA & Process Improvement

Jobtailor; Eden Prairie (MN); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor in Minnesota is seeking an experienced Claims Supervisor to lead multiple examiner teams in liability claims adjudication and performance management. You will mentor staff, ensure compliance with licensing, and drive process improvements while coordinating office projects.

The role emphasizes supervision, QA, and client liaison with a focus on accurate documentation and timely resolutions. A strong background in claims and regulatory licensing is required.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree 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 claims supervisor experience required.
• All 50 states & Home State or Reciprocal licensing required.
• Assures that direct reports are 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 and multiple priorities simultaneously.
• Ability to meet deadlines.
• Computer keyboarding; travel as required.
• Hearing, vision and talking.

Responsibilities

• Supervise multiple teams of examiners and technical staff for liability claims.
• Monitor colleagues' workloads and individual claim activities.
• Provide training and technical/jurisdictional direction on claims adjudication reports.
• Maintain diaries on claims, including complex or high-exposure claims.
• Identify trends, problems, and issues and advise management on recommended actions.
• Inform management of new procedures and ideas for continuous process improvement.
• Coordinate projects for the office.
• Compile, review, and analyze management reports and take appropriate action.
• Support the organization's quality programs.
• Administer company personnel policies and follow staffing standards and training recommendations.
• Interview, hire, and establish colleague performance development plans.
• Conduct colleague performance discussions.
• Provide support, guidance, leadership, and motivation.
• Perform quality reviews on claims according to 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 exceeding examiner authority.
• Monitor third-party claims and review litigated, serious vocational rehabilitation, questionable, and sensitive claims.
• Maintain client contact, promote professional client relationships, and make recommendations based on claim status.
• Provide written claim resumes as requested by clients.
• Ensure claims files are correctly coded and adequately documented.

Skills

Claims supervision

Claims adjudication

Performance management

Quality assurance

Process improvement

Education

Bachelor's degree

High School Diploma or GED

Professional certification

Licensing compliance (All 50 States)

Tools

Licensing compliance

Job description

Jobtailor in Minnesota is seeking an experienced Claims Supervisor to lead multiple examiner teams in liability claims adjudication and performance management. You will mentor staff, ensure compliance with licensing, and drive process improvements while coordinating office projects.

The role emphasizes supervision, QA, and client liaison with a focus on accurate documentation and timely resolutions. A strong background in claims and regulatory licensing is required.