Team Lead, Claims Adjuster – Workers Compensation

This is a fully remote position, open to applicants in Michigan, +4 more locations.

📋 Description

• Oversee several teams of examiners, various product line examiners, and/or multiple technical operations colleagues.

• Recognize and inform management about trends, challenges, and issues while suggesting appropriate actions.

• Update management on new procedures and innovative ideas aimed at continuous process enhancement.

• Coordinate projects in collaboration with management.

• Provide technical and jurisdictional guidance on claims adjudication reports.

• Gather, assess, and analyze management reports and take necessary actions.

• Conduct quality reviews of claims in accordance with audit standards, service contract obligations, and quality benchmarks.

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

• Evaluate reserve amounts for high-cost claims and those that surpass examiner authority.

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

• Maintain client interactions and foster professional relationships with clients.

• Offer recommendations to clients based on the status of claims.

• Provide written summaries of claims as requested by clients.

• Ensure that direct reports are appropriately licensed in the jurisdictions served.

• Confirm that claims files are accurately coded and sufficiently documented.

• Implement company personnel policies and adhere to staffing and training standards.

• Conduct interviews, hire new staff, and set up performance development plans.

• Hold performance discussions with colleagues.

• Offer support, guidance, leadership, and motivation.

• Perform additional duties as assigned.

• Support the organization's quality initiatives.

⛳️ Requirements

• Required licenses as applicable.

• A minimum of six (6) years of claims experience or a comparable mix of education and experience is necessary.

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

• A bachelor’s degree from an accredited college or university is preferred.

• Professional certifications relevant to the line of business are preferred.

• Ability to think clearly and conceptually.

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

• Capability to manage work-related stress effectively.

• Ability to juggle multiple priorities at once.

• Capacity to meet deadlines consistently.

• Proficiency in computer keyboarding.

• Adequate hearing, vision, and verbal communication skills.

• Employment may depend on successfully passing a motor vehicle record (MVR) check, where relevant to the job.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunity to work in an agile environment.

• Career development and promotional growth opportunities.

• Medical, dental, vision, 401K, and matching available from day one.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.