Claims Team Lead I – Workers Compensation

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee various teams of workers' compensation examiners and technical personnel

• Track colleagues' workloads and manage individual claim activities

• Offer training and provide technical/jurisdictional guidance on claims adjudication

• Maintain claim diaries, including frequent updates on complex or high-exposure cases

• Recognize trends, challenges, and issues, advising management on suggested actions

• Update management on new procedures and ideas for continuous process improvement

• Gather, assess, and analyze management reports, taking necessary actions

• Conduct quality reviews on claims to align with audit, service contract, and quality standards

• Serve as a second-level appeal for client and claimant matters, implementing final appeal resolutions

• Evaluate reserve amounts on high-cost and over-authority claims

• Supervise third-party, litigated, serious vocational rehabilitation, questionable, and sensitive claims

• Maintain client interactions, foster professional client relationships, and provide claim recommendations along with written summaries

• Ensure that direct reports are adequately licensed and that claims files are accurately coded and documented

• Enforce personnel policies, conduct interviews and hiring processes, establish performance plans, facilitate performance discussions, and provide leadership and motivation

⛳️ Requirements

• Minimum of 5 years of California Workers' Compensation claims management experience or a comparable combination of education and experience is required

• High School Diploma or GED is required

• Supervisory experience is preferred

• A Bachelor's degree from an accredited college or university is preferred

• Professional certification relevant to the line of business is preferred

• Knowledge of California jurisdiction is essential

• Must ensure that direct reports are properly licensed in the jurisdictions served

🏝️ Benefits

• Flexible work schedule

• Referral incentive program

• Opportunity to work in an agile environment

• Career development and promotional growth opportunities

• Medical, dental, and vision benefits from day one

• 401K with matching contributions

• Paid Time Off (PTO)

• Disability and life insurance

• Employee assistance program

• Flexible spending or health savings accounts

• Additional voluntary benefits available