Workers Compensation Team Leader (Assistant Supervisor)
- medical terminology
- Excel
Not enough detail in this posting to match
POSITION SUMMARY: Under the oversight of the WC Claims Supervisor and Area Manager, the WC Claims Team Leader provides day-to-day supervision, technical guidance, and operational support to a claim’s unit of 10 or more claims personnel, including Claims Examiners and support staff. The Team Leader works directly with Unit Management, Client Services, and clients as a technical expert and advisor to promote consistent claims handling, quality, and compliance with company Best Practices, Customized Handling Instructions, and applicable statutory and regulatory requirements. This position guides and mentors assigned staff, oversees team performance and workflow, conducts quality reviews, and partners with the Claims Supervisor on escalated claims, training needs, and performance-related matters.This position does not carry a personal caseload.
DUTIES AND RESPONSIBILITIES:
- Supervise a claims unit of ten (10) or more claims personnel, including Claims Examiners and support staff.
- Provide day-to-day work directions, technical guidance, and operational support to assigned staff.
- Work directly with Unit Management, Client Services, and clients as a technical expert and advisor on workers’ compensation claims and claims-handling practices.
- Ensure compliance with company Best Practices, Customized Handling Instructions, applicable statutory and regulatory requirements, and established claims-handling procedures.
- Guide, coach, and mentor assigned staff; oversee team performance, work quality, and workflow; and identify training and development needs.
- Monitor work assignments, claim inventories, diary compliance, and timely completion of required claim activities.
- Conduct independent claim-file and quality reviews to evaluate claims-handling quality, reserve accuracy, documentation, compliance, and adherence to established action plans.
- Review and interpret applicable policies, endorsements, coverage provisions, and relevant laws to provide guidance on coverage, liability, exposure, and appropriate claims-handling strategies.
- Review and approve authority requests submitted by assigned Claims Examiners within delegated authority levels and direct staff to obtain additional authority when required.
- Provide technical guidance on complex claims, litigation, negotiations, and settlements within established authority levels.
- Communicate professionally and effectively with clients, claimants, legal counsel, service providers, vendors, management, and internal staff regarding claim status, issues, and resolution strategies.
- Ensure assigned staff maintain effective diary systems and thoroughly document claim activity, evaluations, decisions, communications, and action plans.
- Promptly communicate significant claim developments, coverage concerns, litigation issues, exposure changes, and recommended strategies to the Claims Supervisor, Area Manager, and client, as appropriate.
- Partner with the Claims Supervisor to address performance-related concerns and provide feedback regarding staff development, technical proficiency, and work quality.
- Identify and escalate workflow concerns, quality issues, client-service matters, and other operational risks to the Claims Supervisor or Area Manager.
- Perform other duties as assigned.
EQUIPMENT OPERATED/USED:Computer andother officeequipment.
SPECIAL EQUIPMENT OR CLOTHING:Appropriate office attire when on video or attending client meetings.
Qualifications
QUALIFICATIONSREQUIRED:
Education/Experience: 5 – 7 years of WC experience- Managing cities, counties, public Municipalities a plus. Bachelor’s degree in arelated field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience.
Knowledge, Skills, andAbilities:
- Technical knowledge of coverage, statutory regulations, and medicalterminology.
- Analyticalskills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
- Ability to interact with people at all levels in the businessenvironment.
- Ability to independently and effectively manage very complexclaims.
- Proficient in Word and Excel(preferred).
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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MENTALANDPHYSICALREQUIREMENTS |
- MENTALEFFORT
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- Reasoningdevelopment:
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Followone-ortwo-stepinstructions,routine,repetitivetask.
Carryoutdetailbutuninvolvedwrittenorverbalinstructions,dealwithafewconcrete variables.
Followwritten,verbal,ordiagrammaticinstructions,severalconcretevariables.
X Solvepracticalproblems;varietyofvariableswithlimitedstandardization;interpretinstructions.
Logicalorscientificthinkingtosolveproblems;severalabstractandconcretevariables.
Widerangeofintellectualandpracticalproblems;comprehendmostobscureconcepts. |
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b. Mathematicaldevelopment:
Simpleadditionalandsubtraction;copyingfigures,counting,andrecording.
Add,subtract,multiply,anddividewholenumbers.
X Arithmeticcalculationsinvolvingfractions,decimals,andpercentages.
Arithmetic,algebraic,andgeometriccalculations.
Advancedmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination.
Highlycomplexmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination requires theoretical application. |
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c. Languagedevelopment:
Abilitytounderstandandfollowverbalordemonstratedinstructions;writeidentifyinginformation; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtainbasicinformationsuchasage,occupation,andnumberofchildren;guidepeopleandprovidebasic direction.
Abilitytotranscribedictation;makeappointmentsandprocessmail;writeformlettersorroutinecorrespondence; interpret written work instructions; interview job applicants.
X Abilitytocomposeoriginalcorrespondence,followtechnicalmanuals,andhaveincreasedcontactwith people.
Abilitytoreport,write,oreditarticlesforpublication;preparedeeds,contracts,orleases,prepareand deliver lectures; interview, counsel, or advise people; evaluate technical data. |
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount offorcefrequentlyorconstantlytolift,carry,push,pull,orotherwisemoveobjects.Sedentarywork |
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involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Lightwork:
(Iftheuseofarmand/orlegcontrolsrequiresexertionofforcesgreaterthanthatforSedentaryWork and the worker sits most of the time, the job is rated for Light Work).
Mediumwork:
Heavywork:
Veryheavywork:
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b. Visualrequirementsnecessarytoperformthejob:
Far vision: clarity of vision at 20 feet ormore
X Near vision: clarity of vision at 20 inches orless
X Mid-rangevision:clarityofvisionatdistancesofmorethan20inchesandlessthan20feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Colorvision:abilitytoidentifyanddistinguishcolors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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c. Physicalactivitynecessarytoperformthejobandfrequency(e.g.,continually,frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing |
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Balancing:
X Stooping:
X Kneeling:
X Crouching:
Crawling:
X Reaching:
X Standing:
X Walking:
X Pushing:
X Pulling:
Foot Motion:
X Lifting:
X Fingering:
X Grasping: |
requiredexceedsthatrequiredforordinarylocomotion.
Maintainingbodyequilibriumtopreventfallingwhenwalking,standing,or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
Bending body downward and forward by bending spine at the waist.Thisfactorisimportantifitoccurstoaconsiderabledegreeandrequiresfull use of the lower extremities and back muscles.
Bending legs at knee to come to a rest on knee orknees.
Bendingthebodydownwardandforwardbybendinglegsandspine.Moving about on hands and knees or hands and feet. Extendinghand(s)andarm(s)inanydirection.Particularly for sustained periods of time. Movingaboutonfoottoaccomplishtasks,particularlyforlongdistances.
Usingupperextremitiestoppressagainstsomethingwithsteadyforceinorder to thrust forward, downward, or outward.
Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Using feet to pushpedals.
Raising objects from a lower to a higher position or moving objectshorizontallyfrompositiontoposition.Thisfactorisimportantifitoccursto a considerable degree and requires substantial use of the upper extremities and back muscles.
Picking,pinching,typing,orotherwiseworkingwithfingersratherthanwith the whole hand or arm as in handling.
Applyingpressuretoanobjectwiththefingersandpalm. |
Occasionally |
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Occasionally Occasionally |
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Occasionally Occasionally Occasionally Occasionally |
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Occasionally |
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Frequently |
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Frequently |
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Occasionally |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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XTalking: Expressing or exchanging ideas by means of the spoken word. Thoseactivitiesinwhichworkersmustconveydetailedorimportantspokeninstructions to other workers accurately, loudly, or quickly.
XHearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to |
Frequently
Frequently |
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makefinediscriminationsinsound,suchaswhenmakingfindadjustments on machined parts.
Feeling: Perceivingattributesofobjects,suchassize,shape,temperature,ortexture by touching with skin, particularly that of fingertips.
XRepetitive Substantialmovements(motions)ofthewrists,hands, Motion: and/or fingers. |
Frequently |
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3. WORKINGCONDITIONS
Disagreeablejobconditionstowhichtheemployeemaybeexposedandthefrequency(e.g.,continually,frequently, or occasionally) of this exposure. |
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WORKINGCONDITION ENVIRONMENTAL FACTOR |
NATURE/REASONOF EXPOSURE |
FREQUENCY |
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Dirt/Dust |
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Noise |
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Temperatureextremes |
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Dampness |
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Vibrations |
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Equipmentmovementhazard |
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Chemicals/solvents |
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Electricalshock |
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Significantworkpace/pressure |
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Odors/Fumes |
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Other(specify): |
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Workers Compensation Team Leader (Assistant Supervisor) · Tristar Insurance