Claims Team Lead - Workers Compensation | Jurisdiction: CA - Remote

Sedgwick Claims Management Services Ltd; Orlando (FL); Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional成长

Job summary

Sedgwick Claims Management Services Ltd. is seeking a Claims Team Lead for Workers' Compensation with jurisdiction knowledge in CA and a remote work arrangement.

You will oversee multiple examiner teams, monitor workloads, provide training, and guide adjudication decisions to ensure accuracy and timely resolution. The role requires a strong background in workers' compensation claims, 6+ years of experience with at least 2 years in supervision, and familiarity with CA regulations.

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, including two (2) years as claims supervisor.
• Licensing / Jurisdiction Knowledge: CA

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 and recommends courses of action; informs management of new procedures and ideas for continuous process improvement.
• 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; implements final disposition of the appeal.
• Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
• Maintains contact with the client on claims and promotes a professional client relationship.

Education

High School Diploma or GED

Bachelor's degree (preferred)

Professional certification as applicable to line of business

Job description

Claims Team Lead - Workers Compensation | Jurisdiction: CA - Remote

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Primary Purpose of the Role

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 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 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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Supervisor Responsibilities

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.

Qualifications

• Education & Licensing: 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.
• Experience: Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
• Licensing / Jurisdiction Knowledge: CA

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.

When applicable and appropriate, consideration will be given to reasonable accommodations.

Work Environment Requirements

• Mental: 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; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision and talking.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com