Workers Compensation Claims Team Lead | NY Jurisdiction experience | NY Licensing

Sedgwick; New York (NY); On-site; USD 95,000 - 105,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Career development

Benefits package

Job summary

Sedgwick is seeking a Workers’ Compensation Claims Team Lead with NY jurisdiction experience to oversee multiple claim examiner teams and ensure accurate adjudication and client service.

Ideal candidates have a bachelor’s degree, 10 years of claims experience (2+ years supervising), and NY licensing. You’ll guide training, monitor workloads, maintain diaries on high-exposure claims, and partner with clients to deliver results while upholding regulatory standards.

Qualifications

• Bachelor's degree preferred with relevant experience.
• Ten years claims experience required, with at least two years in supervision.
• NY jurisdiction licensing and knowledge required.
• Licensing and staying current with regulatory requirements as applicable.

Responsibilities

• Supervises multiple teams of examiners and technical staff across claims.
• Monitors workloads and provides training; directs examiner reports on adjudication.
• Reviews management and claims reports; takes corrective action as needed.
• Ensures compliance with audit, contract, and quality standards.
• Acts as second level of appeal for client and claimant issues.
• Maintains client relationships and coordinates with the client on claims status.
• Ensures direct reports are licensed in jurisdictions served.

Skills

Supervisory experience

Claims adjudication

Training & mentoring

Client management

Workload monitoring

Education

Bachelor's degree (preferred)

Professional certifications (as applicable)

Tools

Claims software

Job description

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 | NY Jurisdiction experience | NY Licensing

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?

• Apply your Workers Compensation & supervisory knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
• 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 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.

PRIMARY PURPOSE OF THE ROLE

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Essential Responsibilities May Include

• 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.

Ten (10) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.

Jurisdiction Knowledge: NY

Licensing: NY

TAKING CARE OF YOU

Flexible work schedule.

Referral incentive program.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

• 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

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. 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 (95K - 105K). 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.

#claimsexaminer #claims

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