Claims Team Lead

6 days ago

Santa Barbara, California, United States Insurance Placement Solutions Full time

Insurance Placement Solutions has an immediate opening for a Workers' Compensation Claims Team Lead with our client in the California area. As a member of our client's claims team, utilize your knowledge of workers' compensation to independently investigate, evaluate, and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer and resolve claims in a timely manner in accordance with legal statutes, policy provisions, and company guidelines.

Workers Compensation Claims Team Lead Responsibilities

  • Supervises multiple teams of examiners, single or 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 a 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 reviews on claims in compliance with audit requirements, service contract requirements, and quality standards.
  • Acts as the 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 the client.
  • Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to the client as suggested by the claim status; and provides written resumes of specific claims as requested by the 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.

Experience

  • 6+ years of experience handling workers' compensation lost-time/indemnity claims as a workers compensation claims adjuster
  • 2+ years of experience in a supervisory or team lead role
  • Must have California claims handling experience

Certifications

  • SIP Certification

Education

  • A high school diploma or equivalent is required

About Insurance Placement Solutions

IPS is an insurance staffing and recruiting firm dedicated to the insurance industry, including workers' compensation claims jobs in the Los Angeles, CA area. Our services are designed to be a resource for clients to gain access to high-caliber talent. Many of our clients do not have the dedicated manpower to quickly fill their temporary, temporary-to-hire, or direct hire vacancies. That is where we come in. Our clients are able to utilize our services to maintain business as usual during unforeseen interruptions and fluctuating business needs. Plus, our candidates benefit from gaining backdoor access to highly sought-after positions with top companies in the industry.

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