Claims Examiner - Workers Compensation (Hybrid- West Hills, CA)

Sedgwick; Fallbrook (CA); Hybrid; USD 80,000 - 92,000; Full time

Job summary

Sedgwick in West Hills, CA is seeking a Claims Examiner - Workers Compensation to adjudicate complex claims with a customer-focused approach in a hybrid work model.

You will analyze claims, negotiate settlements within authority, and communicate with claimants and clients while upholding service standards and regulatory requirements. California WC knowledge and SIP licensing are preferred.

Qualifications

• 5+ years of claims management experience or equivalent.
• High School Diploma or GED required; a Bachelor's degree is preferred.
• SIP license or eligibility within one year in California.

Responsibilities

• Analyze workers' compensation claims to determine benefits and adjudicate within service levels.
• Negotiate settlements within designated authority.
• Communicate claim activity with claimants and clients.
• Report claims to excess carriers and respond to directions promptly.

Skills

Claims adjudication

Negotiation

Client communication

Education

High School Diploma or GED

Bachelor’s degree preferred

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

Claims Examiner - Workers Compensation (Hybrid- West Hills, CA)

Job Description

Are you lookingfor an opportunity to join a global industry leader where you can bring yourbig ideasto help solve problems for some of the world’s best brands?

• Apply your knowledge and experience toadjudicatecomplex customer claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients whorepresentvirtually everyindustry andcomprisesome 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,financialand professional needs.

ARE YOU AN IDEAL CANDIDATE?

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

OFFICE LOCATIONS: West Hills, CA (Agile) 3 days remote

PRIMARY PURPOSE OF THE ROLE:

To analyzeWorkers Compensationclaims on behalf of our valued clients todeterminebenefits 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 toan appropriateandtimelyresolution by investigating and gathering information todeterminethe 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 andtimelymanner.

QUALIFICATIONS

Education & Licensing:5years of claims management experience or equivalent combination of education and experiencerequired.

• High School Diploma or GEDrequired. Bachelor’s degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Licensing / Jurisdiction Knowledge:

SIP required or must be obtained within one (1) year of employment; California workers compensation jurisdictional knowledge required.

TAKING CARE OF YOU

• Flexibleworkschedule.
• Referralincentiveprogram.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on dayone.

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 - $92,000. 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.

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.

Sedgwickis an Equal Opportunity Employer and a Drug-Free Workplace.