Sedgwick
Overview
By joining Sedgwick, you'll be part of something truly meaningful. Its 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, theres no limit to what you can achieve. Newsweek Recognizes Sedgwick as Americas Greatest Workplaces National Top Companies. Certified as a Great Place to Work. Fortune Best Workplaces in Financial Services & Insurance. Position
Claims Manager I Workers Compensation Primary Purpose
To supervise the operation of multiple teams of examiners and technical staff for workers compensation 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. Seeking California, Central, and Eastern experience. Responsibilities
Supervise 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. Identify and advise management of trends, problems, and issues as well as recommended course of action; inform management of new procedures and ideas for continuous process improvement; and coordinate with management projects for the office. Provide technical/jurisdictional direction to examiner reports on claims adjudication. Compile reviews and analyze management reports and take appropriate action. Perform quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. Act as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implement final disposition of the appeal. Review reserve amounts on high cost claims and claims over the authority of the individual examiner. Monitor third party claims; maintain periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client. Maintain contact with the client on claims and promote a professional client relationship; make recommendations to client as suggested by the claim status; and provide written resumes of specific claims as requested by client. Ensure that direct reports are properly licensed in the jurisdictions serviced. Ensure claims files are coded correctly and adequate documentation is made by claims examiners.
Additional Functions and Responsibilities
Perform other duties as assigned. Support 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/motivational skills Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation 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 Note : Credit security clearance, confirmed via a background credit check, is required for this position. 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. 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. Sedgwick is the worlds leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companys expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com #J-18808-Ljbffr
By joining Sedgwick, you'll be part of something truly meaningful. Its 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, theres no limit to what you can achieve. Newsweek Recognizes Sedgwick as Americas Greatest Workplaces National Top Companies. Certified as a Great Place to Work. Fortune Best Workplaces in Financial Services & Insurance. Position
Claims Manager I Workers Compensation Primary Purpose
To supervise the operation of multiple teams of examiners and technical staff for workers compensation 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. Seeking California, Central, and Eastern experience. Responsibilities
Supervise 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. Identify and advise management of trends, problems, and issues as well as recommended course of action; inform management of new procedures and ideas for continuous process improvement; and coordinate with management projects for the office. Provide technical/jurisdictional direction to examiner reports on claims adjudication. Compile reviews and analyze management reports and take appropriate action. Perform quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. Act as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implement final disposition of the appeal. Review reserve amounts on high cost claims and claims over the authority of the individual examiner. Monitor third party claims; maintain periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client. Maintain contact with the client on claims and promote a professional client relationship; make recommendations to client as suggested by the claim status; and provide written resumes of specific claims as requested by client. Ensure that direct reports are properly licensed in the jurisdictions serviced. Ensure claims files are coded correctly and adequate documentation is made by claims examiners.
Additional Functions and Responsibilities
Perform other duties as assigned. Support 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/motivational skills Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation 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 Note : Credit security clearance, confirmed via a background credit check, is required for this position. 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. 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. Sedgwick is the worlds leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companys expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com #J-18808-Ljbffr