California Workers’ Comp Claims Specialist

Sedgwick; California (MO); On-site; USD 80,000 - 105,000; Full time

Job summary

Sedgwick is hiring a Workers’ Compensation Claims Examiner to analyze and adjudicate California workers’ compensation claims with high exposure, including litigation and rehabilitation considerations.

The role requires doing complex investigations, negotiating settlements, and ensuring timely payments and filings while meeting client service requirements and regulatory standards in California.

Qualifications

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

Responsibilities

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine exposure and resolve.
• Negotiate settlement of claims within designated authority.
• Calculate and assign reserves; 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 authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost-efficient claims resolution.
• Report claims to the excess carrier and respond to requests of direction professionally and promptly.

Education

Bachelor's degree

Professional certification (line of business)

Job description

Sedgwick is hiring a Workers’ Compensation Claims Examiner to analyze and adjudicate California workers’ compensation claims with high exposure, including litigation and rehabilitation considerations.

The role requires doing complex investigations, negotiating settlements, and ensuring timely payments and filings while meeting client service requirements and regulatory standards in California.