Claims Examiner - Workers Compensation | CA Jurisdiction

Sedgwick Claims Management Services Ltd; San Diego (CA); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Job summary

Sedgwick is seeking a Claims Examiner to analyze complex California workers' compensation claims and determine benefits due. You will handle high exposure cases, manage litigation, settlements, and reserves, and ensure timely adjudication aligned with client requirements.

The role involves reporting to the claims leadership, coordinating with counsel, and leveraging Sedgwick's resources to navigate subrogation and cost-effective resolutions while maintaining compliance and service standards.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Four (4) 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 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 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 analysis

Regulatory knowledge

Negotiation

Litigation coordination

Education

Bachelor's degree

Job description

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.

• 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: Four (4) 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.

WORK LOCATIONS

Roseville, CA San Diego, CA

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.
• 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.

For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $100,000.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

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

• 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.

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

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 building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

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.

#Claims #ClaimsExaminer #LI-Remote #LI-Hybrid

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 - Workers Compensation | 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? Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.