Claims Team Lead Assistant - Workers Compensation | Roseville, CA

Claims Team Lead Assistant – Workers Compensation | Roseville, CA Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Office Locations Roseville, CA or San Diego, CA – Hybrid (3 days in office, 2 days remote) 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. 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 & Licensing Bachelor’s degree from an accredited college or university preferred. Professional certifications as applicable to line of business preferred. Experience Five (5) years claims management or equivalent combination of education and experience required. Licensing / Jurisdiction Knowledge: California workers compensation claim handling experience | SIP Certified Benefits Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one. 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. Salary Range For the jurisdiction noted in this job posting only, the range of starting pay for this role is $95,000-$105,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Legal and Equal Opportunity Statements Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwickis an Equal Opportunity Employer and a Drug-Free Workplace. Additional Note 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. #J-18808-Ljbffr Dormont Manufacturing Co