Workers Compensation Claims Examiner | Must Reside in CA

Newsweek Recognizes Sedgwick as America’s Greasiest Workplace

About the role

Join Sedgwick, a global industry leader, where you can bring your big ideas to help solve problems for some of the world’s best brands. This role involves analyzing complex or technically difficult workers' compensation claims, negotiating settlements, and managing the litigation process.

Responsibilities

• Analyze and process complex or technically difficult workers' compensation claims
• Negotiate settlement of claims within designated authority
• Calculate and assign timely and appropriate reserves to claims
• Manage reserve adequacy throughout the life of the claim
• Calculate and pay benefits due
• Approve and make timely claim payments and adjustments
• Settle claims within designated authority level
• Prepare necessary state filings within statutory limits
• Manage the litigation process
• Coordinate vendor referrals for additional investigation and/or litigation management
• Leverage cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
• Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
• Report claims to the excess carrier
• Respond to requests of directions in a professional and timely manner
• Communicate claim activity and processing with the claimant and the client
• Maintain professional client relationships
• Ensure claim files are properly documented and claims coding is correct
• Refer cases as appropriate to supervisor and management

Requirements

• 5 years of claims management experience or equivalent combination of education and experience required
• High School Diploma or GED required
• Bachelor's degree from an accredited college or university preferred
• Professional certification as applicable to line of business preferred
• California workers' compensation claims handling experience | SIP certified preferred

Qualifications

• Licensing / Jurisdiction Knowledge: California workers' compensation claims handling experience | SIP certified preferred

Benefits

A flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.