Claims Team Lead Assistant - Workers Compensation | Roseville, CA

Claims Team Lead Assistant – Workers Compensation (Roseville, CA) 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 Analyze and process 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. Negotiate settlement of claims within designated authority. Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy through the life of the claim. Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level. Prepare necessary state filings within statutory limits. Manage the litigation process; ensure timely and cost effective claims resolution. Coordinate vendor referrals for additional investigation and/or litigation management. Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and Social Security and Medicare offsets. Report claims to the excess carrier; respond to requests of directions in a professional and timely manner. Communicate claim activity and processing with the claimant and the client; maintain professional client relationships. Ensure claim files are properly documented and claims coding is correct. Refer cases as appropriate to supervisor and management. Lead team meetings and assign accountability for follow-up items. Gather important compliance/claims processing information to be presented at team meetings. Assist in interviews of adjusters, clerical staff and provide feedback to hiring manager. Provide limited assistance/support to team lead with monthly review of adjuster workloads; note trends and suggest adjustments when necessary (may include up to three direct reports). ADDITIONAL FUNCTIONS and RESPONSIBILITIES Perform other duties as assigned. Support the organization's quality program(s).

SUPERVISORY RESPONSIBILITIES

Administer company personnel policies in all areas and follow company staffing standards and training recommendations. Interview, hire and establish colleague performance development plans; conduct colleague performance discussions. Provide 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.

TAKING CARE OF YOU

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. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. 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 accounts, and other additional voluntary benefits.

EMPLOYMENT PROVISIONS

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. sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement