Remote Claims Team Lead - Workers' Comp & Adjudication

Sedgwick Claims Management Services Ltd; Orange (CA); Remote; USD 105,000 - 115,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K on day one

Referral incentives

Career development

Promotional growth

Job summary

Sedgwick is seeking a Workers' Compensation Claims Team Lead in Orange, CA. The role oversees multiple examiners and technical staff, providing guidance on adjudication and ensuring proper documentation and licensing standards.

The ideal candidate has 6+ years of claims experience with supervisor exposure, a high school diploma or GED, and preferably a Bachelor's degree. We offer flexible schedules, development opportunities, and a comprehensive benefits package.

Qualifications

• Education & Licensing: 6 years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
• High School Diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• Licensing / Jurisdiction Knowledge: SIP & California Workers Compensation claims handling experience.

Responsibilities

• Supervises multiple teams of examiners and technical operations colleagues, delegating duties as needed and ensuring proper licensing and documentation standards.
• Provides technical and jurisdictional guidance on claims adjudication, including quality reviews and reserve evaluations for high-cost or complex claims.
• Acts as a second-level appeal authority for client and claimant issues, implementing final decisions.
• Identifies trends, issues, and opportunities for process improvement; advises management and coordinates related projects.
• Monitors third-party and sensitive claims, including litigated and vocational rehabilitation cases.
• Maintains professional client relationships, offering recommendations and written summaries as needed.
• Ensures accurate claim coding and documentation by examiners.

Skills

Claims supervision

Leadership

Training

Quality reviews

Claims adjudication

Jurisdiction knowledge

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is seeking a Workers' Compensation Claims Team Lead in Orange, CA. The role oversees multiple examiners and technical staff, providing guidance on adjudication and ensuring proper documentation and licensing standards.

The ideal candidate has 6+ years of claims experience with supervisor exposure, a high school diploma or GED, and preferably a Bachelor's degree. We offer flexible schedules, development opportunities, and a comprehensive benefits package.