Claims Team Leader

Job Description

Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, Claim Your Future.&rd;

PRIMARY PURPOSE: To be responsible for the technical and operational functions of claim unit(s) including compliance with company standards and industry best practices; to ensure consistent delivery of quality services; to be responsible for staffing and training needs, as well as staff development, career and succession planning; and to assist the Operations Manager with budget preparation and profit and loss management for the office; to lead the operation of teams which administer claims for clients; and to provide technical and jurisdictional direction, overall management and training of claims staff in applicable jurisdictions.


Provides technical and jurisdictional direction and training to claims examiners on claims adjudication.

Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.

Monitors claims examiner workloads ensuring compliance with service standards.

Maintains contact with the client on claims and promotes a professional client relationship; provides recommendations to client as suggested by the claim status; and provides written reports of specific claims as requested by client.

Monitors management reports relating to location or office performance.


Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.


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.


Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.

Seven (7) years of claims management experience required. Supervisory experience preferred.

Skills & Knowledge

Good technical knowledge of claims management

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

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

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.

Sedgwick is an Equal Opportunity Employer

and a

Drug-Free Workplace

Additional Information: Licenses in California, Colorado, Florida, Georgia, Illinois, Kansas, Iowa, Michigan, Mississippi, Missouri, and Minnesota preferred.

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Sedgwick CMS is an Equal Opportunity Employer. All applicants will be considered without regard to race, color, religion, gender, national origin, sexual orientation, age, marital status, medical condition, disability or any other legally protected status.


Sedgwick Claims Management Services

Job Code

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