Workers Compensation Claims Examiner

About the role

Joining Sedgwick means being part of a global industry leader dedicated to helping some of the world’s best brands navigate the unexpected. Our 33,000 colleagues work every day to support people facing challenges, fostering a caring culture and promoting work-life balance.

Responsibilities

• Analyze complex or technically difficult workers' compensation claims to determine benefits due.
• Work with high-exposure claims involving litigation and rehabilitation.
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Identify subrogation opportunities and negotiate settlements within designated authority.
• Manage the litigation process to ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Leverage strategic vendor partnerships to reduce overall claim costs for clients.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier and respond professionally and promptly to client inquiries.
• Communicate claim activity and processing with claimants and clients, maintaining professional client relationships.
• Ensure claim files are properly documented and claims coding is accurate.
• Referrals to supervisor and management as needed.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Five (5) years of claims management experience or equivalent combination of education and experience required.
• California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.