Workers Compensation Claims Team Lead – NY Jurisdiction

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

📋 Description

• Oversee various teams of workers compensation examiners alongside technical operations staff.

• Track workloads and individual claim activities diligently.

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

• Maintain claim diaries, with particular attention to frequent updates for complex or high-exposure claims.

• Detect trends, challenges, and issues, and suggest appropriate actions.

• Notify management of new procedures and continuous improvement initiatives.

• Coordinate projects in collaboration with management.

• Compile, examine, and analyze management reports, taking necessary actions accordingly.

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

• Serve as the second-level appeal authority for client and claimant issues, implementing final resolutions.

• Assess reserves on high-cost claims and those that exceed examiner authority.

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

• Maintain client contact to foster professional relationships.

• Provide recommendations on claim status and prepare written claim summaries upon request.

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

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

• Administer personnel policies while adhering to staffing and training standards.

• Conduct interviews, hire personnel, establish performance development plans, and engage in performance discussions.

• Offer support, guidance, leadership, and motivation to achieve optimum performance.

⛳️ Requirements

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

• Licenses as necessary for the role.

• Relevant professional certifications applicable to the line of business are preferred.

• A minimum of ten (10) years of claims experience or a comparable combination of education and experience is required.

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

• Familiarity with the New York jurisdiction is essential.

• New York licensing is required.

• Capability to supervise multiple teams of examiners and technical personnel.

• Proficiency in managing multiple priorities and meeting deadlines.

• Strong analytical and conceptual thinking abilities.

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

• Ability to manage work-related stress effectively.

• Proficient in computer keyboarding.

• Adequate hearing, vision, and communication skills.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• Comprehensive medical, dental, and vision insurance.

• 401(k) plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance coverage.

• Employee assistance program.

• Flexible spending or health savings accounts.

• Additional voluntary benefits.

• Emphasis on work-life balance.

• Professional development opportunities available.

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