Claims Team Lead – Workers Compensation

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

📋 Description

• Oversee the operations of various teams of examiners and technical personnel for workers' compensation services for clients;

• Monitor team members' workloads, deliver training, and track individual claim activities;

• Provide technical and jurisdictional guidance on examiner reports pertaining to claims adjudication;

• Maintain a comprehensive diary on team claims, including frequent updates on complex or high-exposure cases.

• Supervise multiple teams of examiners and product line specialists, along with at least seven technical operations colleagues, ensuring wide oversight;

• May assign certain responsibilities to team members within the unit.

• Recognize and inform management of trends, issues, and challenges while recommending actionable solutions; updates management on new procedures and ideas for ongoing process enhancements; and collaborates with management on office projects.

• Provide technical and jurisdictional guidance on examiner reports regarding claims adjudication.

• Compile, review, and analyze management reports, taking appropriate actions.

• Conduct quality reviews on claims in accordance with audit requirements, service contract stipulations, and quality standards.

• Serve as a second level of appeal for client and claimant concerns related to specific claims, procedures, or special requests; finalize disposition of the appeals.

• Review reserve amounts on high-cost claims and those exceeding the authority of individual examiners.

• Monitor third-party claims; regularly assess litigated claims, significant vocational rehabilitation cases, questionable claims, and sensitive claims as identified by the client.

• Maintain communication with clients regarding claims and foster a professional relationship; offer recommendations based on claim statuses; and provide written summaries of specific claims upon client request.

• Ensure that direct reports hold the necessary licenses for the jurisdictions served.

• Verify that claims files are correctly coded and that claims examiners provide adequate documentation.

• Perform other assigned duties while supporting the organization's quality programs.

⛳️ Requirements

• A minimum of six (6) years of claims experience or a comparable combination of education and experience, including two (2) years in a supervisory role.

• High School Diploma or GED is required.

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

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

• Knowledge of licensing and jurisdiction for FL, AL, AK, GA, Mississippi, TN, SC, and NC.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• A wide-ranging and comprehensive benefits package that includes medical, dental, vision, and 401K from day one.