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Claims Team Lead, Professional Liability (Medical Malpractice)
PRIMARY PURPOSE *: * To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, 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 PL Specialists and/or multiple claims colleagues for wide span of control; and delegates duties to others within the unit as needed.
Identifies and advises management of trends, problems, and issues; makes recommendations on course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for assigned office(s).
Provides technical/jurisdictional direction to PL Specialists on claims issues and resolution.
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.
Reviews reserve amounts on high cost claims and claims over the authority of individual PL Specialists.
Maintains periodic review of claims that are litigated, sensitive, or questionable as determined by the client.
Maintains contact with client on claims and promotes professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes on specific claims as requested by client.
Maintains frequent diaries on complex or high exposure claims.
Ensures that direct reports are properly licensed in the jurisdiction serviced.
Ensures claim files are coded correctly and adequate documentation is made by PL Specialists.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization 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. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
Eight (8) years of claims management experience related to professional liability claims or equivalent combination of education and experience required to include two (2) years of claims supervisor experience.
Skills & Knowledge
Thorough knowledge of claims management processes and procedures for multiple product lines
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
Ability to meet or exceed Performance Competencies
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.
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 $115,000 . 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.
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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.
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.
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