Liability Claims Team Lead - GL & Auto Exp. Required | Must Reside in CA
Hispanic Alliance for Career Enhancement, Roseville, CA, United States
Liability Claims Team Lead - GL & Auto Exp. Required | Must Reside in CA
PRIMARY PURPOSE
To supervise a team of liability claims examiners and adjusters; 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 FUNCTIONS AND RESPONSIBILITIES
Supervises a team of eight liability claims examiners and adjusters.
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.
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. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
Six (6) years of Liability claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
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.
TAKING CARE OF YOU
Flexible work schedule
Career development
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one
Compensation and Benefits
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 $95,000-$115,000/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.
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.
#J-18808-Ljbffr
PRIMARY PURPOSE
To supervise a team of liability claims examiners and adjusters; 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 FUNCTIONS AND RESPONSIBILITIES
Supervises a team of eight liability claims examiners and adjusters.
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.
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. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
Six (6) years of Liability claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
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.
TAKING CARE OF YOU
Flexible work schedule
Career development
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one
Compensation and Benefits
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 $95,000-$115,000/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.
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.
#J-18808-Ljbffr