Claims Team Lead - Workers Compensation
Company: Sedgwick
Location: Louisville
Posted on: September 15, 2023
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Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a
positive impact on the world through the people and organizations
we serve. If you are someone who is driven to make a difference,
who enjoys a challenge and above all, if you're someone who cares,
there's a place for you here. Join us and contribute to Sedgwick
being a great place to work.
Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer
Claims Team Lead - Workers Compensation
PRIMARY PURPOSE: 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; and to
maintain a diary on claims in the teams including frequent diaries
on complex or high exposure claims.
ESSENTIAL FUNCTIONS and 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.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
SUPERVISORY RESPONSIBILITIES
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.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university
preferred. Licenses as required. Professional certifications as
applicable to line of business preferred.
Experience
Six (6) years of claims experience or equivalent combination of
education and experience required to include two (2) years claims
supervisor experience.
Skills & Knowledge
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
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to
reasonable accommodations.
Mental : Clear and conceptual thinking ability; excellent judgment,
troubleshooting, problem solving, analysis, and discretion; ability
to handle work-related stress; ability to handle multiple
priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE : Credit security clearance, confirmed via a background credit
check, is required for this position.
The statements contained in this document are intended to describe
the general nature and level of work being performed by a colleague
assigned to this description. They are not intended to constitute a
comprehensive list of functions, duties, or local variances.
Management retains the discretion to add or to change the duties of
the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free
Workplace.
If you're excited about this role but your experience doesn't align
perfectly with every qualification in the job description, consider
applying for it anyway! Sedgwick is building a diverse, equitable,
and inclusive workplace and recognizes that each person possesses a
unique combination of skills, knowledge, and experience. You may be
just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring
counts
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing - one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Louisville , Claims Team Lead - Workers Compensation, Other , Louisville, Kentucky
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