Claims Team Lead - Workers Compensation | Brea, 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?
- Apply your knowledge and experience to 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 a 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 to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We are looking for an experienced California workers' compensation professional with strong leadership, technical claims expertise, and a client-focused approach to managing complex and high-exposure claims.
OFFICE LOCATIONSBrea, CA - Hybrid (2 days in office, 3 days remote)
PRIMARY PURPOSE OF THE ROLE: Oversees a team of examiners and technical staff handling workers compensation claims for a dedicated client. Manages workloads, provides training, and monitors individual claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex or high-exposure case.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE- Supervises a team of examiners and technical operations colleagues, delegating duties as needed and ensuring proper licensing and documentation standards.
- Provides technical and jurisdictional guidance on claims adjudication, including quality reviews and reserve evaluations for high-cost or complex claims.
- Acts as a second-level appeal authority for client and claimant issues, implementing final decisions.
- Identifies trends, issues, and opportunities for process improvement; advises management and coordinates related projects.
- Monitors third-party and sensitive claims, including litigated and vocational rehabilitation cases.
- Maintains professional client relationships, offering recommendations and written summaries as needed.
- Ensures accurate claim coding and documentation by examiners.
QUALIFICATIONS Education & Licensing: 6 years of claims experience or equivalent combination of education and experience preferred.
- High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
Licensing / Jurisdiction Knowledge: California workers compensation claim handling experience required | SIP Certified
TAKING CARE OF YOU - Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENTWhen 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
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $105,000-$118,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
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