Claims Team Lead - Workers Compensation | Concord, CA

Overview

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Team Lead - Workers Compensation | Concord, CA

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• Adjudicate complex customer claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
• Be part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Leverage Sedgwick’s broad, global network of experts to both learn from and share insights.
• Take advantage of a variety of professional development opportunities to perform at your best and grow your career.
• Enjoy flexibility and autonomy in daily work, location, and career path.
• Access diverse and comprehensive benefits to support mental, physical, financial, and professional needs.

Are you an ideal candidate? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Concord, CA (Hybrid)

To supervise the operation of workers compensation examiners 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.

• Supervises a team of examiners; may delegate some duties to others within the unit.
• Identifies and advises management of trends, problems, and issues; recommends courses of action; informs management of new procedures and ideas for continuous process improvement; 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 beyond the authority of the individual examiner.
• Monitors third-party claims; maintains periodic 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; provides written resumes of specific claims as requested by client.
• Ensures direct reports are properly licensed in the jurisdictions serviced.
• Ensures claims files are coded correctly and adequate documentation is made by claims examiners.

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

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…