Sedgwick

Claims Team Lead, Auto

Sedgwick$75K — $95K *
US-Anywhere
+ 4 other locationsRemote
Finance & Insurance
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree preferred; licenses as required
  • 6+ years of claims experience or equivalent, including 2 years in supervision
  • Thorough knowledge of claims management processes for multiple product lines
  • Excellent communication and presentation skills
  • Strong leadership and analytical abilities

Responsibilities

  • Supervises and manages multiple teams of examiners and technical operations colleagues
  • Advises management on trends, problems, and recommended improvements
  • Provides technical direction on claims adjudication processes
  • Analyzes management reports and takes necessary actions
  • Conducts quality reviews ensuring compliance with audits and service standards
  • Acts as the second level of appeal for claims disputes
  • Maintains client communication and relationship regarding claims

Benefits

  • Opportunities for professional development and training
  • Support for obtaining relevant licenses and certifications
  • Flexible work environment and potential for remote work
  • Access to a comprehensive health benefits package
  • Participation in a quality improvement program
Full Job Description
Claims Team Lead, Auto PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for liability claims 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 RESPONSIBLITIES MAY INCLUDE • 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). 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 skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies Work environment requirements include - Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. 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.

About Sedgwick

Sedgwick is a global provider of insurance, risk management, and related services. The company was founded in 1969 and is headquartered in Boston, Massachusetts. Sedgwick offers a range of services to clients in various industries, including property and casualty insurance, workers' compensation, and disability management. The company has a team of experienced professionals who work closely with clients to develop customized solutions that meet their specific needs. Sedgwick has a reputation for delivering high-quality service and has been recognized for its excellence in the insurance industry.
Learn more about Sedgwick
Size
10,000 employees
Industry
Founded
1969

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