Workers Compensation Claims Team Lead | MD, VA, DC, WV, DE Jurisdictional Knowledge | WV & DE Licensing

About the role

Join Sedgwick, a global industry leader recognized by Fortune and Newsweek, to bring your expertise to help solve problems for some of the world’s best brands. This role involves supervising multiple teams of examiners and technical staff for workers compensation claims, providing technical/jurisdictional direction, and maintaining a diary on complex or high exposure claims.

Responsibilities

• Supervises multiple teams of examiners, multiple product line examiners, and/or several (minimum seven) technical operations colleagues for a wide span of control.
• 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.
• 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.
• Safeguards claims files are coded correctly and adequate documentation is made by claims examiners.

Qualifications

• 5 years of claims management experience or equivalent combination of education and experience required.
• A high school diploma or GED required.
• A bachelor's degree from an accredited college or university preferred.
• A professional certification as applicable to line of business preferred.
• Jurisdiction Knowledge: MD, VA, DC, WV, DE Licensing: WV & DE