CA WC Claims Examiner — Remote, High-Exposure & Litigation

Sedgwick; San Francisco (CA); Hybrid; USD 80,000 - 105,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

401K on day one

Job summary

Sedgwick in California seeks a seasoned Workers' Compensation Claims Examiner to analyze complex CA claims, including litigated and high-exposure matters, and to ensure adjudication within service expectations and client requirements.

The role offers hybrid or remote work options for CA residents, with opportunities to grow professionally, comprehensive benefits, and a supportive culture that emphasizes work-life balance and high-quality service to our clients.

Qualifications

• Three (3) years of California workers' compensation claims management experience or equivalent combination of education and experience.
• California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.

Responsibilities

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state filings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Skills

CA workers' comp experience

Litigation management

Reserving & settlements

Education

Bachelor's degree

Job description

Sedgwick in California seeks a seasoned Workers' Compensation Claims Examiner to analyze complex CA claims, including litigated and high-exposure matters, and to ensure adjudication within service expectations and client requirements.

The role offers hybrid or remote work options for CA residents, with opportunities to grow professionally, comprehensive benefits, and a supportive culture that emphasizes work-life balance and high-quality service to our clients.