Remote Claims Team Lead I (CA Experience)

Sedgwick; Montpelier (VT); Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Career development

Agile environment

Benefits package

Job summary

Sedgwick is hiring for a Senior Supervisory Claims Lead focused on Workers’ Compensation with CA experience. This remote US role involves supervising multiple examiner teams, directing claims adjudication, and ensuring regulatory and client requirements are met.

A strong background in CA WC claims and leadership is essential. The position emphasizes professional development, flexible work arrangements, and a comprehensive benefits package.

Qualifications

• 5 years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
• Supervisory experience preferred.
• High School Diploma or GED required; Bachelor's degree from an accredited college or university preferred.
• Jurisdiction Knowledge: California

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.

Skills

Supervisory skills

Workers' Compensation

Jurisdiction knowledge

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

Sedgwick is hiring for a Senior Supervisory Claims Lead focused on Workers’ Compensation with CA experience. This remote US role involves supervising multiple examiner teams, directing claims adjudication, and ensuring regulatory and client requirements are met.

A strong background in CA WC claims and leadership is essential. The position emphasizes professional development, flexible work arrangements, and a comprehensive benefits package.