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Sedgwick · 4 days ago
Claims Team Lead - Workers Compensation
Maryland, United States
Full-time
Onsite
Senior Level
6+ years exp
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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 the 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 the client.
Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to the client as suggested by the claim status; and provides written resumes of specific claims as requested by the 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).
Qualification
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Required
Bachelor's degree from an accredited college or university preferred
Licenses as required
Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience
Thorough knowledge of claims management processes and procedures for multiple product lines
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
Preferred
Professional certifications as applicable to line of business preferred
Benefits
Flexible work schedule
Professional development opportunities
Health and wellness programs
Company
Sedgwick
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.
10,001+ employees
H1B Sponsorship
Sedgwick has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Trends of Total Sponsorships
2023 (3)
2022 (9)
2021 (14)
2020 (9)
Funding
Current Stage
Late StageTotal Funding
$501.78MKey Investors
Caisse de Depot et Placement du Quebec
2018-12-01Private Equity· Undisclosed
2018-09-12Acquired· by The Carlyle Group ($6.7B)
2016-09-28Private Equity· $500M
Leadership Team
Michael Arbour
Chief Executive Officer
Kimberly George
Senior Vice President
Recent News
2024-03-04
2024-01-22
2023-12-04
Company data provided by crunchbase
