Claims Team Lead

PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, 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 in the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES 

• Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) 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 to include two (2) years claims supervisor experience.

Skills & Knowledge

• Thorough knowledge of claims management processes and procedures for multiple product lines

• 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.