California WC Claims Examiner: Complex Claims

Sedgwick; California; On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Career development

Benefits package (medical, dental, 401

401K on day one

Job summary

Sedgwick is seeking a California workers' compensation claims examiner to adjudicate complex, high-exposure claims and manage the full lifecycle from investigation to settlement. You will work within a broad, global network to deliver outstanding service and leverage Sedgwick’s expertise and resources.

The ideal candidate has four years of California WC claims experience, strong negotiation and investigative skills, and jurisdictional knowledge.

Qualifications

• Bachelor's degree from an accredited college or university preferred; professional certification as applicable to line of business preferred.
• Four (4) years of California workers' compensation claims management experience or equivalent education/experience required.
• California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.

Responsibilities

• Analyze complex or technically difficult California workers' compensation claims to determine benefits due; manage claims through investigation, benefit determination, settlement negotiation, and resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign reserves; ensure reserve adequacy throughout the life of the claim.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost effective claims resolution.
• Report claims to the excess carrier and respond to directions promptly.

Skills

California WC experience

Problem solving

Negotiation

Investigation

Education

Bachelor's degree

Job description

Sedgwick is seeking a California workers' compensation claims examiner to adjudicate complex, high-exposure claims and manage the full lifecycle from investigation to settlement. You will work within a broad, global network to deliver outstanding service and leverage Sedgwick’s expertise and resources.

The ideal candidate has four years of California WC claims experience, strong negotiation and investigative skills, and jurisdictional knowledge.