California Workers Compensation Claims Adjuster / Examiner | Remote

Sedgwick; California; Hybrid; USD 80,000 - 105,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional成长

Job summary

Sedgwick in California is seeking an experienced Remote Workers' Compensation Claims Examiner to analyze complex claims, including litigated and high-exposure cases, and to determine benefits with a focus on timely adjudication and subrogation where applicable.

The ideal candidate has California WC claims management experience, SIP certification (preferred/required depending on client), and a strong commitment to service quality, accuracy, and regulatory compliance.

Qualifications

• California workers' compensation claims management experience.
• Bachelor's degree from an accredited college or university preferred.
• California jurisdictional knowledge required; SIP certification preferred 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 exposure; manages claims through action plans to resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns reserves to claims 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 in a professional and timely manner.

Skills

California WC claims experience

SIP certification

California jurisdiction knowledge

Education

Bachelor's degree

Professional certification as applicable to line of business

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Remote Workers Compensation Claims Examiner | CA Jurisdiction

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?

• California workers' compensation claims experience required.
• SIP certification preferred/required depending on client assignment and state of residence.

ARE YOU AN IDEAL CANDIDATE?

We're looking claim's professionals with California workers' compensation experience who enjoy solving complex problems and delivering outstanding service. The ideal candidate has experience handling litigated and high-exposure claims, understands California jurisdictional requirements, and can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.

PRIMARY PURPOSE OF THE ROLE

To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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 clams 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.

QUALIFICATIONS

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience: Three (3) years of California workers compensation claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

When applicable and appropriate, consideration will be given to reasonable accommodations.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding

Auditory/Visual: Hearing, vision and talking

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $105,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

#LI-REMOTE #LI-HYBRID #CaliforniaWorkersComp #CAWorkersComp #WorkersCompClaims #ClaimsAdjuster #ClaimsExaminer #LitigatedClaims #InsuranceClaims

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.