Workers Compensation Claims Team Lead – Jurisdictions: DE, IL, LA, MO, NJ, OK, TN, TX – License Required

This is a fully remote position, open to applicants in Alabama, +25 more states.

📋 Description

• Evaluate intricate or technically challenging general liability claims to ascertain due benefits.

• Manage high-exposure liability claims that involve litigation and rehabilitation processes.

• Ensure that the ongoing assessment of claims aligns with service expectations, industry best practices, and client specifications.

• Detect subrogation opportunities and engage in settlement negotiations.

• Provide support for the team leader during their absence from the office.

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

• Supervise colleagues' workloads, offer training, and monitor individual claim activities.

• Deliver technical and jurisdictional guidance on claims adjudication reports.

• Maintain claim diaries, including regular updates for complex or high-exposure claims.

• Recognize trends, challenges, and issues while recommending appropriate actions.

• Coordinate management projects and ongoing process improvement initiatives.

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

• Conduct quality reviews of claims in accordance with audit standards, service contracts, and quality metrics.

• Serve as a second-level appeal authority for client and claimant concerns and execute final resolutions.

• Evaluate reserves on high-cost claims and those exceeding examiner authority.

• Oversee third-party claims and periodically review litigated, vocational rehabilitation, questionable, and sensitive claims.

• Maintain communication with clients, recommend actions based on claim status, and provide written summaries of claims.

• Ensure that direct reports possess the necessary licenses in serviced jurisdictions.

• Guarantee that claims files are accurately coded and thoroughly documented.

• Implement personnel policies and staffing standards.

• Conduct interviews, hire personnel, create performance development plans, and lead performance discussions.

• Offer support, direction, leadership, and motivation to enhance performance.

⛳️ Requirements

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

• Required licenses for relevant jurisdictions.

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

• Two (2) years of claims experience or an equivalent combination of education and experience is required.

• Supervisory experience is not mandatory.

• Knowledge of jurisdictions: DE, IL, LA, MO, NJ, OK, TN, TX.

• Ability to analyze complex or technically challenging claims.

• Ability to manage workers' compensation claims and high-exposure liability claims involving litigation and rehabilitation.

• Ability to identify subrogation opportunities and negotiate settlements effectively.

• Ability to supervise multiple teams of examiners and technical staff.

• Ability to provide technical and jurisdictional guidance.

• Ability to review claims, reserves, reports, and documentation thoroughly.

• Ability to manage multiple priorities and adhere to deadlines.

• Strong analytical, problem-solving, and decision-making skills, along with the ability to think clearly and conceptually.

• Capacity to handle work-related stress effectively.

• Proficient computer keyboarding skills.

• Adequate hearing, vision, and verbal communication abilities.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotional growth.

• Medical, dental, vision, 401K with matching.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits.

• Reasonable accommodations available.

• Flexible work location and career path options.

• Bonus eligibility may apply.