Claims Team Lead - Work Comp Claims

Charlotte, NC

Post Date: 08/02/2018 Job ID: 2528
PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for single or multiple product lines which administer workers compensation and/or general liability 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 in the teams including frequent diaries on complex or high exposure claims. 
ESSENTIAL FUNCTIONS and RESPONSIBILITIES: 
  • Supervises multiple teams of examiners, single of 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. 

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 




NOTE: 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.

SKILLS & KNOWLEDGE: 

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

EXPERIENCE: 

  • Six (6) years claims experience or equivalent combination of education and experience required. 
  • Two (2) years claims supervisor experience preferred. 
  • Ability to meet or exceed Service Expectations

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