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Sedgwick · 1 month ago

Assistant Team Lead Workers Compensation

Bartlesville, OK

Full-time

Onsite

Mid, Senior Level

$70K/yr - $80K/yr

5+ years exp

Sedgwick is a leading claims management services company with a commitment to supporting their clients through the unexpected. The Assistant Team Lead for Workers Compensation will analyze complex claims, ensure timely adjudication, and provide leadership and support to the team while managing high exposure claims.

BankingInsuranceRisk Management

Responsibilities

Analyzes and processes complex or technically difficult workers’ compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution

Negotiates settlement of claims within designated authority

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy through the life of the claim

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within designated authority level

Prepares necessary state filings within statutory limits

Manages the litigation process; ensures timely and cost effective claims resolution

Coordinates vendor referrals for additional investigation and/or litigation management

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients

Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner

Communicates claim activity and processing with the claimant and the client; maintains professional client relationships

Ensures claim files are properly documented and claims coding is correct

Refers cases as appropriate to supervisor and management

Leads team meetings and assigns accountability for follow-up items

Gathers important compliance/claims processing information to be presented at team meetings

Assists in interviews of adjusters, clerical staff and provides feedback to hiring manager

Provides limited assistance/support to team lead with monthly review of adjuster workloads; notes trends and suggests adjustments when necessary. May include up to (3) three direct reports

Performs other duties as assigned

Supports the organization's quality program(s)

Administers company personnel policies in all areas and follows company staffing standards and training recommendations

Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions

Provides support, guidance, leadership and motivation to promote maximum performance

Qualification

Claims managementInsurance principlesNegotiation skillsAnalytical skillsMicrosoft OfficeCommunication skillsOrganizational skillsInterpersonal skillsTeamwork

Required

Five (5) years claims management or equivalent combination of education and experience

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Excellent negotiation skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies