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Sedgwick · 4 weeks ago

Workers Compensation Claims Team Lead | NY Jurisdictional Knowledge - Remote

United States

Full-time

Remote

Mid, Senior Level

$95K/yr - $105K/yr

5+ years exp

Sedgwick is a leading claims management services company, and they are seeking a highly motivated and experienced Workers' Compensation Claims Team Lead. This role involves supervising multiple teams of workers' compensation examiners, ensuring timely and accurate claims handling while adhering to New York jurisdictional regulations.

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

Qualification

Workers' Compensation ClaimsNew York Jurisdictional KnowledgeClaims Handling ExperiencePublic Entity Claims ManagementSupervisory ExperienceWCCP CertificationAIC Certification

Required

Minimum of (5) years of workers' compensation claims handling experience

Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures

Experience with Public Entity claims management a plus

High school diploma or equivalent; a college degree or relevant certifications (e.g., WCCP, AIC) is a plus