Workers Compensation Claims Team Lead | New York Jurisdiction

We are seeking a highly motivated and experienced Workers' Compensation Claims professionals to join our team. The ideal candidate will have at least 3 years of claims handling experience, with a strong background in New York jurisdictional regulations and processes. Supervisory experience preferred. This position is responsible for supervising multiple teams of workers' compensation examiners, ensuring timely and accurate decisions while adhering to all applicable laws and regulations.

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

ESSENTIAL 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. 

QUALIFICATIONS

• Experience:

  • Minimum of (3) years of workers' compensation claims handling experience.

  • Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures.

  • Experience with Public Entity claims management a plus

  • Supervisory experience a plus

• Education:

  • High school diploma or equivalent; a college degree or relevant certifications (e.g., WCCP, AIC) is a plus.

• Skills and Abilities:

  • Strong understanding of workers' compensation claims processes, policies, and legal requirements in New York.

  • Excellent written and verbal communication skills.

  • Strong analytical skills with attention to detail and accuracy.

  • Ability to manage multiple claims simultaneously and prioritize workload effectively.

  • Proficiency with claims management software and Microsoft Office Suite (Excel, Word, Outlook).

  • Ability to negotiate settlements and resolve claims disputes effectively.

TAKING CARE OF YOU

• Flexible work schedule. 

• Capped Case Load.

• In-depth training.

• Sedgwick funded licensing.

• Referral incentive program. 

• Opportunity to work in an agile or remote environment.

• Career development and promotional growth opportunities. 

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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 ( 85,000 - 95,000). 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.