Sedgwick Claims Management Services

Claims management and risk solutions provider

Workforce Absence Team Lead - Claims Assistant Team

Claims AdjudicationConfirmed live in the last 24 hours

Full-timeDubuque, IA, USANo salary listed

About the Job

Requirements

Six years of claims experience or an equivalent combination of education and experience is required.
Licenses are required as applicable.
Thorough knowledge of disability claims management procedures and processes is required.
Proficiency with Microsoft Office products is required.
Leadership, management, and motivational skills are required.
Analytical and interpretive skills are required.
Organizational skills are required.
Interpersonal skills are required.
Negotiation skills are required.
Ability to work in a team environment is required.
Ability to meet or exceed performance competencies is required.
Ability to think clearly and conceptually, exercise judgment, troubleshoot, solve problems, analyze information, and use discretion is required.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines is required.
Ability to perform computer keyboarding is required.
Ability to travel as required is required.

Responsibilities

Supervise the operations of multiple teams of disability claims examiners and technical staff, monitor colleagues' workloads and individual claim activities, provide training, give technical and jurisdictional direction on claim adjudication reports, and maintain diaries on claims, including frequent diaries on complex or high-exposure claims.
Supervise multiple teams of examiners and/or several technical operations colleagues across a wide span of control, and delegate duties within the unit as appropriate.
Identify and advise management of trends, problems, and issues, recommend courses of action, inform management of new procedures and process-improvement ideas, and coordinate office projects with management.
Provide technical and jurisdictional direction on examiner reports concerning claims adjudication.
Compile, review, and analyze management reports and take appropriate action.
Review claims for quality in compliance with audit requirements, service contract requirements, and quality standards.
Act as the second level of appeal for client and claimant issues involving claim-specific, procedural, or special requests, and implement the final disposition of appeals.
Review reserves on high-cost claims and claims exceeding the authority of individual examiners.
Monitor third-party claims and periodically review litigated claims, serious vocational rehabilitation claims, questionable claims, and sensitive claims as determined by the client.
Maintain client contact regarding claims, promote professional client relationships, make recommendations based on claim status, and provide written claim summaries when requested.
Ensure direct reports are properly licensed in the jurisdictions served.
Ensure claims files are correctly coded and claims examiners provide adequate documentation.
Administer company personnel policies and follow company staffing standards and training recommendations.
Interview and hire colleagues, establish performance development plans, and conduct performance discussions.
Provide support, guidance, leadership, and motivation to promote maximum performance.
Support the organization's quality programs.
Perform other duties as assigned.

Desired Qualifications

A bachelor's degree from an accredited college or university is preferred.
Professional certifications applicable to the line of business are preferred.
Two years of claims supervisory experience is preferred.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Workforce Absence Team Lead - Claims Assistant Team

PRIMARY PURPOSE: To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims within the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Supervises multiple teams of examiners and/or several technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
Provides technical/jurisdictional direction to examiner reports on claims adjudication.
Compiles, reviews, and analyzes management reports and takes appropriate action.
Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
Assures that direct reports are properly licensed in the jurisdictions serviced.
Ensures claims files are coded correctly and adequate documentation is made by claims examiners.

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 & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.

Experience
Six (6) years of claims experience or equivalent combination of education and experience required. Two (2) years of claims supervisory experience preferred.

Skills & Knowledge

Thorough knowledge of claims management procedures and processes for disability
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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.

About the Company

Sedgwick Claims Management Services

Claims management and risk solutions provider

Sedgwick manages claims and risk for insurers, corporations, and public entities. Its services cover the full claims lifecycle, including clinical case management, networks, and cost-containment programs, plus specialized work like home inspections and property appraisals. The company operates by charging fees for these managed services that coordinate medical care, assess losses, and support timely resolution. Sedgwick differentiates itself through its integrated, end-to-end approach to claims management and its strong emphasis on caring for people, DEI, and client outcomes. Its goal is to help clients resolve claims efficiently, restore property and brands, and reduce costs through targeted resources deployed at the right time to improve outcomes.

Company size: 10,001+
Company stage: Growth Equity (Non-Venture Capital)
Total funding: $1.5B
Headquarters: Memphis, TN
Founded: 1969

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