California Workers' Comp Claims Examiner – Complex Claims

Sedgwick; Roseville (CA); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Career development

Benefits package

Job summary

Sedgwick in California seeks a Claims Examiner - Workers' Compensation to analyze complex CA WC claims, including high-exposure cases, determine benefits, and coordinate investigations and settlements.

Ideal candidates have California WC experience, litigation knowledge, and a commitment to excellent client service. The role supports ongoing adjudication, subrogation considerations, and compliance with CA jurisdictional requirements.

Qualifications

• Bachelor's degree preferred.
• Four years of California workers' compensation claims management experience or equivalent.
• California jurisdictional knowledge and SIP licensing (or to be obtained within one year).

Responsibilities

• Analyzes and processes complex or technically difficult California workers' compensation claims by investigating and gathering information to determine exposure; manages claims through action plans to resolution.
• Negotiates settlement within designated authority.
• Calculates and assigns reserves and manages reserve adequacy.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within authority.
• Prepares necessary state filings within statutory limits.
• Manages the litigation process; ensures timely and cost effective resolution.
• Reports claims to the excess carrier and responds to directions professionally.

Skills

California WC experience

Litigation handling

Analytical skills

Customer service

Education

Bachelor's degree

Job description

Sedgwick in California seeks a Claims Examiner - Workers' Compensation to analyze complex CA WC claims, including high-exposure cases, determine benefits, and coordinate investigations and settlements.

Ideal candidates have California WC experience, litigation knowledge, and a commitment to excellent client service. The role supports ongoing adjudication, subrogation considerations, and compliance with CA jurisdictional requirements.