Claims Team Lead Assistant - Worker's Compensation

The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.Claims Team Lead Assistant - Worker's CompensationIF YOU CARE, THERE’S A PLACE FOR YOU HEREFor a career path that is both challenging and rewarding, join Sedgwick’s talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets—their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.For more than 50 years, Sedgwick has been helping employers answer virtually every question there is about workers’ compensation. We have experience in nearly every type of industry and region and provide the industry’s broadest range of programs and services.PRIMARY PURPOSE: To train, organize, develop and deliver core curriculum; to maintain a schedule of regularly delivered training in each assigned areas; and to ensure high quality training is delivered supporting internal and external client needs. 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.ESSENTIAL FUNCTIONS and RESPONSIBILITIESEnsures that the training process is properly coordinated, monitored documented and evaluated.

Coordinates and facilitates technical systems training.

Delivers training program that meets, supports, and incorporate business needs, objectives, strategies, and policies.

Identifies the present and future needs of training classes and existing colleagues after analysis of overall course framework.

Creates and maintains assessment and evaluation tools used consistently for internal users.

Maintains product knowledge, industry knowledge, and familiarity with claims management internal processes.

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 RESPONSIBILITIESPerforms other duties as assigned.

Supports the organization's quality program(s).

SUPERVISORY RESPONSIBILITIESAdministers 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.

QUALIFICATIONSEducation & 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 & KnowledgeSubject 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

WORK ENVIRONMENTWhen 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 deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingNOTE: Credit security clearance, confirmed via a background credit check, is required for this position.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.