Workforce Absence Team Lead

Sedgwick Claims Management Services Ltd; Dubuque (IA); On-site; USD 60,000 - 90,000; Full time

Job summary

Sedgwick Claims Management Services in the United States seeks a Team Lead to supervise multiple teams of examiners and staff handling disability claims. You will monitor workload, provide training, and deliver technical direction on adjudication, while maintaining diaries and ensuring high-quality output for complex or high-exposure claims.

The role requires leadership, strong communication, and a track record in claims management.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Six (6) years of claims experience or equivalent combination of education and experience.
• Two (2) years of claims supervisory experience preferred.
• Thorough knowledge of claims management procedures and processes for disability.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Leadership/management/motivational skills.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance.
• Competencies.

Responsibilities

• Supervises multiple teams of examiners and/or several technical operations colleagues for a wide span of control.
• 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.
• Provides technical/jurisdictional direction to examiner reports on claims adjudication.
• Compiles, reviews, and analyzes management reports and takes appropriate action.
• Perform 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.
• 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.
• Ensures claims files are coded correctly and adequate documentation is made by claims examiners.

Skills

Claims management knowledge

Communication skills

Leadership

Analytical skills

Organizational skills

Interpersonal skills

Negotiation skills

Teamwork

Performance standards

Competencies

Education

Bachelor's degree

Tools

Microsoft Office

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 Workforce Absence Team Lead

Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002 Dublin, OH : 5500 Glendon Court Dublin OH 43016

PRIMARY PURPOSE

To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, 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 within the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Supervises multiple teams of examiners and/or several 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.
• Perform 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned. Supports the organization's quality program(s).

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

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.

Experience

• Six (6) years of claims experience or equivalent combination of education and experience required.
• Two (2) years of claims supervisory experience preferred.

Skills & Knowledge

• Thorough knowledge of claims management procedures and processes for disability.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Leadership/management/motivational skills.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance.
• Competencies.

WORK ENVIRONMENT

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.
• Ability to meet deadlines.

Physical

• Computer keyboarding.
• Travel as required.

Auditory/Visual

• Hearing.
• Vision and talking.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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.