Claims Team Lead – Workers Compensation

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

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

• Track colleagues' workloads and individual claim activities.

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

• Keep detailed diaries on claims, particularly those that are complex or involve high exposure.

• Recognize trends, challenges, and issues, and recommend actions to management.

• Organize management projects along with ongoing process improvement initiatives.

• Gather, review, and analyze management reports.

• Conduct quality reviews on claims to ensure compliance with audit, service contract, and quality standards.

• Serve as the second level of appeal for client and claimant concerns, implementing final resolutions.

• Assess reserve amounts on high-cost claims and those exceeding examiner authority.

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

• Maintain communication with clients, fostering professional relationships, and making claim-status recommendations.

• Provide clients with written summaries of claims upon request.

• Ensure claims files are accurately coded and thoroughly documented.

• Implement company personnel policies and staffing standards.

• Conduct interviews, hire new staff, and create performance development plans for colleagues.

• Facilitate performance discussions with colleagues, providing leadership, guidance, and motivation.

• Support the organization's quality programs.

⛳️ Requirements

• High School Diploma or GED is mandatory.

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

• Professional certification relevant to the line of business is preferred.

• A minimum of six (6) years of claims experience or an equivalent combination of education and experience is required.

• At least two (2) years of experience in a claims supervisory role is required.

• Knowledge of CA licensing and jurisdiction.

• Direct reports must hold appropriate licenses in the jurisdictions they serve.

• Ability for clear and conceptual thinking.

• Strong judgment, troubleshooting, problem-solving, analytical skills, and discretion.

• Capability to manage work-related stress effectively.

• Proficiency in handling multiple priorities at once.

• Ability to meet deadlines consistently.

• Competence in computer keyboarding.

• Willingness to travel as necessary.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotions.

• Medical, dental, and vision coverage.

• 401K plan available from day one.

• Support for work-life balance.

• Professional development opportunities.

• Flexibility and autonomy in daily work, location, and career trajectory.

• Comprehensive benefits that support mental, physical, financial, and professional needs.