Claims Examiner | Riverside, CA or Ontario, CA

Sedgwick; Ontario (CA); Hybride; USD 95 000 - 105 000; Plein temps

Avantages offerts par ce poste

Flexible schedule

Referral incentive program

Career development growth

Full benefits: medical, dental, vision

Résumé du poste

Sedgwick is seeking a Claims Examiner in Riverside, CA or Ontario, CA. You will analyze workers' compensation claims to determine benefits due, ensure timely adjudication, and support clients with accurate claims processing.

The role requires CA workers' compensation knowledge, 3+ years of experience, and a HS diploma; a bachelor's degree is preferred. A comprehensive benefits package and growth opportunities are included.

Qualifications

• 3+ years claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required; Bachelor's degree preferred.
• Professional certification as applicable to line of business preferred.

Responsabilités

• Analyze Workers' Compensation claims to determine benefits due and adjudicate within service expectations.
• Negotiate settlements within designated authority.
• Communicate claim activity with the claimant and client.
• Report claims to the excess carrier and respond to directions promptly.

Connaissances

Claims management experience

Negotiation

Formation

High School Diploma or GED

Bachelor’s degree preferred

Description du poste

Riverside, CA

Ontario, CA

R79450

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

Claims Examiner | Riverside, CA or Ontario, CA

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?

PRIMARY PURPOSE OF THE ROLE:

To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

• Education & Licensing: 3 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Licensing / Jurisdiction Knowledge: 3 or more years California workers compensation jurisdictional knowledge required, SIP required or must be obtained within one (1) year of employment

Taking Care Of You

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

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 $95,000-105,000. 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.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

#LI-REMOTE #LI-HYBRID

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.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com