Remote Claims Team Lead - Workers' Comp (CA)

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

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.