Apply on Employer Site

Sedgwick · 2 months ago

Workers Compensation Claims Team Lead | VA Jurisdiction | Remote

United States

Full-time

Remote

Senior Level

5+ years exp

Sedgwick is a global industry leader in claims management, dedicated to providing innovative solutions to clients across various industries. The Workers Compensation Claims Team Lead will supervise multiple teams, adjudicate complex claims, and ensure compliance with service expectations while promoting a culture of empathy and accountability.

BankingInsuranceRisk Management

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

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