Remote Claims Team Lead – Workers' Compensation

Sedgwick; Miami (FL); Remote; USD 80,000 - 106,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Paid time off

Job summary

Sedgwick is seeking a Claims Team Lead for Workers Compensation with jurisdiction and licensing NV requirements. This remote role supervises multiple examiners and staff, ensuring compliance, quality, and effective client communication across a broad portfolio.

The ideal candidate has 6+ years in claims, 2+ years in supervision, and NV licensing; a Bachelor's degree is preferred. This position offers a flexible schedule, strong benefits, and remote work options, with NV as the jurisdiction focus.

Qualifications

• 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.
• Professional certification as applicable to line of business preferred.

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

Claims supervision

Team management

Quality assurance

Education

High School Diploma or GED

Bachelor's degree preferred

NV Licensing required

Job description

Sedgwick is seeking a Claims Team Lead for Workers Compensation with jurisdiction and licensing NV requirements. This remote role supervises multiple examiners and staff, ensuring compliance, quality, and effective client communication across a broad portfolio.

The ideal candidate has 6+ years in claims, 2+ years in supervision, and NV licensing; a Bachelor's degree is preferred. This position offers a flexible schedule, strong benefits, and remote work options, with NV as the jurisdiction focus.