Sedgwick
Assistant Claims Team Lead - Workers Compensation | Austin, TX
Sedgwick, Austin, Texas, us, 78716
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®Most Loved Workplace®Forbes Best-in-State Employer
Assistant Claims Team Lead - Workers Compensation | Austin, TX
PRIMARY PURPOSE:
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers' compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide backup for team lead when out of the office.
* Candidates must be commutable to the Austin, TX office *
BENEFITSCompetitive salary
Flexible work schedule
Referral Incentive Program
Internal career progression and development
Benefits eligibility and 401(k) with company match day 1
ESSENTIAL FUNCTIONS and 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.ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.Supports the organization's quality program(s).SUPERVISORY RESPONSIBILITIES
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.QUALIFICATIONS
Education & LicensingBachelor's degree from an accredited college or university preferred. Professional certifications as applicable to line of business preferred.
ExperienceFive (5) years claims management or equivalent combination of education and experience required.
Skills & Knowledge
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 skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsExcellent negotiation skillsGood interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance Competencies
#claims #claimsteamlead
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®Most Loved Workplace®Forbes Best-in-State Employer
Assistant Claims Team Lead - Workers Compensation | Austin, TX
PRIMARY PURPOSE:
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers' compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide backup for team lead when out of the office.
* Candidates must be commutable to the Austin, TX office *
BENEFITSCompetitive salary
Flexible work schedule
Referral Incentive Program
Internal career progression and development
Benefits eligibility and 401(k) with company match day 1
ESSENTIAL FUNCTIONS and 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.ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.Supports the organization's quality program(s).SUPERVISORY RESPONSIBILITIES
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.QUALIFICATIONS
Education & LicensingBachelor's degree from an accredited college or university preferred. Professional certifications as applicable to line of business preferred.
ExperienceFive (5) years claims management or equivalent combination of education and experience required.
Skills & Knowledge
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 skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsExcellent negotiation skillsGood interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance Competencies
#claims #claimsteamlead
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.