Workers Compensation Claims Team Lead

Sedgwick; Chicago (IL); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401K with company match

PTO and disability insurance

Flexible spending accounts or health-s

Employee assistance program

Job summary

Sedgwick is seeking a Workers' Compensation Claims Team Lead to supervise multiple examiner teams for clients across DE, IL, LA, MO, NJ, OK, TN, TX. License requirements apply.

This role supports adjudication, subrogation, and client service with a strong emphasis on compliance and professional development. The ideal candidate analyzes complex claims, provides jurisdictional guidance, and maintains ongoing client communication while promoting a culture of quality and efficiency.

Qualifications

• Bachelor's degree preferred. Licenses as required.
• Two years of claims experience or equivalent combination of education and experience.
• Jurisdiction knowledge: DE, IL, LA, MO, NJ, OK, TN, TX.
• Supervisory experience not required.

Responsibilities

• Supervise multiple teams of examiners and technical staff; monitor workloads and provide training.
• Provide technical/jurisdictional direction to examiner reports on claims adjudication.
• Review management reports and ensure quality and compliance with audit requirements.
• Maintain client relationship and provide written updates on claims as requested.
• Ensure direct reports are properly licensed in the serviced jurisdictions.

Skills

Leadership & supervision

Client relationship management

Regulatory knowledge

Education

Bachelor's degree

Licenses as required

Tools

Claims processing software

Job description

Workers Compensation Claims Team Lead | Dedicated Client | Jurisdictions: DE, IL, LA,MO,NJ,OK,TN, TX | License: Required

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | Dedicated Client | Jurisdictions: DE, IL, LA,MO,NJ,OK,TN, TX | License: Required

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

ARE YOU AN IDEAL CANDIDATE?

To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure liability claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide backup for team lead when out of the office.

PRIMARY PURPOSE OF THE ROLE

To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS and 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.

SUPERVISORY RESPONSIBILITIES

Administers company personnel policies in all areas and follows company staffing standards and training recommendations. Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. Provides support, guidance, leadership, and motivation to promote maximum performance.

QUALIFICATIONS

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred. two (2) years of claims experience or equivalent combination of education and experience required. Supervisory experience not required. Jurisdiction Knowledge: DE, IL, LA,MO,NJ,OK,TN, TX Licensing: required

WORK ENVIRONMENT REQUIREMENTS INCLUDE

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical: Computer keyboarding. Auditory/Visual: Hearing, vision and talking.

Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location.

For the jurisdiction noted in this job posting only, the range of starting pay for this role is (range)(bonus eligibility, if applicable).

A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
• A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

In addition, Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

#claimsexaminer #claims #LI-REMOTE

For more, see sedgwick.com