Remote Claims Team Lead, Workers' Comp (NV)

Sedgwick; Montpelier (VT); Remote; USD 80,000 - 106,000; Full time

Benefits offered by this job

Flexible schedule

Comprehensive benefits

Job summary

Sedgwick in the United States is seeking a Claims Team Lead – Workers Compensation with jurisdiction NV and remote work options. You will supervise multiple examiner teams, monitor workloads, provide training, and maintain high-quality adjudication for complex claims.

The ideal candidate has at least six years of claims experience, two years in supervision, NV licensing, and a bachelor’s degree preferred. Sedgwick offers flexible scheduling, comprehensive benefits, and opportunities to grow

Qualifications

• Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university 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: NV REQUIRED

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).

Skills

Leadership

Supervision

Claims experience

Licensing NV

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick in the United States is seeking a Claims Team Lead – Workers Compensation with jurisdiction NV and remote work options. You will supervise multiple examiner teams, monitor workloads, provide training, and maintain high-quality adjudication for complex claims.

The ideal candidate has at least six years of claims experience, two years in supervision, NV licensing, and a bachelor’s degree preferred. Sedgwick offers flexible scheduling, comprehensive benefits, and opportunities to grow