Claims Team Lead – Workers Compensation

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🐊 Florida – Remote

🐊 Florida – Remote

💵 $67k - $85k / year

⏰ Full Time

🟠 Senior

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; • to monitor colleagues' workloads, provide training, and monitor individual claim activities; • to provide technical/jurisdictional direction to examiner reports on claims adjudication; • to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. • 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).

🎯 Requirements

• Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience. • High School Diploma or GED required. • Bachelor's degree from an accredited college or university preferred. • Professional certification as applicable to line of business preferred. • Licensing / Jurisdiction Knowledge: FL, AL, AK, GA, Mississippi, TN, SC, NC.

🏖️ Benefits

• Flexible work schedule. • Referral incentive program. • Career development and promotional growth opportunities. • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.