California Workers' Comp Claims Examiner - Hybrid/Remote

Sedgwick Claims Management Services Ltd; United States; Hybrid; USD 80,000 - 105,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive program

Career development & growth

Job summary

Sedgwick is seeking an experienced claims professional to analyze and adjudicate complex California workers' compensation claims. The role requires handling litigated and high-exposure cases, investigation, benefit determinations, settlements, and ongoing adjudication to meet client service standards.

Must reside in California and be eligible for Hybrid or Remote work. The ideal candidate has a Bachelor's degree, California WC claims experience, and SIP licensing or the ability to obtain it

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Three (3) years of California workers' compensation claims management experience or equivalent combination of education and experience required.
• California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.

Responsibilities

• Analyzes and processes complex or technically difficult California workers' compensation claims by investigating and gathering information to determine exposure.
• 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 fillings 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

Claims management

California knowledge

Litigation handling

Education

Bachelor's degree

Certification (SIP or equivalent)

Job description

Sedgwick is seeking an experienced claims professional to analyze and adjudicate complex California workers' compensation claims. The role requires handling litigated and high-exposure cases, investigation, benefit determinations, settlements, and ongoing adjudication to meet client service standards.

Must reside in California and be eligible for Hybrid or Remote work. The ideal candidate has a Bachelor's degree, California WC claims experience, and SIP licensing or the ability to obtain it