Claims Team Lead - Workers Compensation

📋 Description

• • As a Claims Team Lead specializing in Workers' Compensation at Sedgwick, you will play a pivotal role in overseeing the operational efficiency and effectiveness of multiple claims examination teams. This position is crucial for ensuring that clients receive exceptional service and that complex workers' compensation claims are managed with expertise and adherence to all jurisdictional requirements. You will be instrumental in fostering a high-performing team environment, driving continuous improvement, and maintaining the highest standards of claims adjudication and client satisfaction. Your leadership will directly impact the successful resolution of claims, contributing to Sedgwick's mission of helping people through the unexpected and reinforcing its reputation as a leader in the industry.
• • Your day-to-day responsibilities will encompass a wide range of leadership and operational tasks. You will supervise multiple teams of examiners, potentially across various product lines, managing a significant span of control that may include a minimum of seven technical operations colleagues. A key part of your role will involve monitoring the workloads of your direct reports, providing them with essential training, and closely observing individual claim activities to ensure accuracy and compliance. You will offer critical technical and jurisdictional direction to examiners as they adjudicate claims, ensuring that all decisions are well-founded and align with relevant laws and regulations. Maintaining a proactive diary system for claims within your teams, with particular attention to complex or high-exposure cases, will be essential for effective claim management. You will also be responsible for compiling, reviewing, and analyzing management reports, taking appropriate action based on the data to identify trends, address issues, and recommend courses of action to senior management. Furthermore, you will conduct quality reviews of claims to ensure compliance with audit requirements, service contract stipulations, and established quality standards, acting as a second level of appeal for client and claimant issues, and implementing final dispositions for these appeals. You will review reserve amounts for high-cost claims and those exceeding an individual examiner's authority, and meticulously monitor third-party claims, litigated claims, serious vocational rehabilitation claims, questionable claims, and sensitive claims as defined by the client, conducting periodical reviews to ensure proper handling and resolution. Maintaining consistent and professional communication with clients regarding claim status, making recommendations based on claim progression, and providing detailed written resumes of specific claims upon client request will be integral to fostering strong client relationships.
• • You will be joining Sedgwick, a company recognized for its commitment to its colleagues and clients. Sedgwick has been acknowledged by Newsweek as one of America's Greatest Workplaces and is certified as a Great Place to Work®. The company is also recognized by Fortune among the Best Workplaces in Financial Services & Insurance. This role is part of a dedicated team focused on delivering exceptional claims management services. You will contribute to a supportive and collaborative work environment where colleagues are encouraged to grow their careers, experience a caring culture, and achieve a healthy work-life balance. The company fosters an environment where there is no limit to what you can achieve, driven by a shared purpose of helping people through the unexpected.
• • In this role, you will have the opportunity to significantly develop your leadership and claims management expertise. You will gain in-depth knowledge of workers' compensation claims adjudication across multiple jurisdictions and product lines, honing your ability to provide expert technical and jurisdictional direction. You will enhance your analytical and problem-solving skills by reviewing management reports, identifying trends, and implementing process improvements. The position offers a chance to refine your interpersonal and negotiation skills through interactions with clients, claimants, and your team. You will also develop your ability to manage and motivate a team, fostering a culture of high performance and continuous learning. By successfully leading your teams and ensuring the effective management of complex claims, you will contribute to Sedgwick's overall success and potentially open doors to further career advancement within the organization.