Claims Examiner - Workers Compensation | Dedicated Client

Sedgwick; California; On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision

401K on day one

Disability and life insurance

Employee assistance program

Flexible spending or health savings

Job summary

Sedgwick in California is seeking a seasoned Claims Examiner to adjudicate Workers' Compensation claims with a focus on accuracy and client service. This role emphasizes analyzing complex claims, determining benefits due, and maintaining timely adjudication within established guidelines.

The successful candidate will negotiate settlements within authority, communicate progress to claimants and clients, and collaborate with Sedgwick’s extensive network to support effective resolutions and strong

Qualifications

• 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.

Responsibilities

• Analyze Workers Compensation claims on behalf of clients to determine benefits due and adjudicate within service expectations.
• Investigate and gather information to determine exposure on the claim and develop action plans for timely resolution.
• Negotiate settlement of claims within designated authority.
• Communicate claim activity and processing with the claimant and the client.
• Report claims to the excess carrier and respond to directions promptly and professionally.

Skills

Claims management

Client communication

Education

High School Diploma or GED

Bachelor's degree preferred

Tools

Claims processing software

Job description

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - Workers Compensation | Dedicated Client 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 workers compensation 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.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‑managed intake environment.

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.
• 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.

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.

Benefits:

• Diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
• Excellent judgment, troubleshooting, problem solving, analysis, and discretion; Computer keyboarding
• Auditory/Visual: Hearing, vision and talking
• 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.
• Flexible work schedule.
• Career development and promotional growth opportunities.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

#Claims #ClaimsExaminer

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