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Sedgwick

Assistant Claims Team Lead - Workers Compensation | Orange, CA

Orange, CA Full time

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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Assistant Claims Team Lead - Workers Compensation | Orange, CA

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers' compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide backup for team lead when out of the office.

OFFICE LOCATIONS

Orange, CA - Hybrid

Candidates outside of this location may be considered based on qualifications.


ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Analyzes and processes complex or technically difficult workers’ compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy through the life of the claim.
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within designated authority level.
  • Prepares necessary state filings within statutory limits.
  • Manages the litigation process; ensures timely and cost effective claims resolution.
  • Coordinates vendor referrals for additional investigation and/or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
  • Ensures claim files are properly documented and claims coding is correct.
  • Refers cases as appropriate to supervisor and management.
  • Leads team meetings and assigns accountability for follow-up items.
  • Gathers important compliance/claims processing information to be presented at team meetings.
  • Assists in interviews of adjusters, clerical staff and provides feedback to hiring manager.\
  • Provides limited assistance/support to team lead with monthly review of adjuster workloads; notes trends and suggests adjustments when necessary. May include up to (3) three direct reports.


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. Professional certifications as applicable to line of business preferred.

 
Experience
Five (5) years claims management or equivalent combination of education and experience required.

  • Must have jurisdictional experience handling California Workers Compensation claims.


Skills & Knowledge

  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Excellent negotiation skills
  • Good interpersonal 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


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.

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 (64,022.00 - 95,000.00) USD annual salary. Commission eligible role. 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. #claimsexaminer #claims #hybrid

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

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.