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Company

Sedgwick · 8 hours ago

Claims Team Lead - Workers Compensation (REMOTE- Needs California Experience)

Texas, United States

Full-time

Remote

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 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.

Performs other duties as assigned.

Supports the organization's quality program(s).

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims managementClaims supervisor experienceOralMicrosoft OfficeMotivational skills

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

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

Preferred

Bachelor's degree from an accredited college or university preferred.

Licenses as required.

Professional certifications as applicable to line of business preferred.

Company

Sedgwick

Glassdoor

3.3

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.

Founded in 1969

Memphis, Tennessee, USA

10001+ employees

http://www.sedgwick.com

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

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Trends of Total Sponsorships

2023 (3)

2022 (9)

2021 (14)

2020 (9)