Claims Examiner - Workers Compensation | Jurisdiction: CA or NV | Licensing: required

Sedgwick; United States; Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Career development

Job summary

Sedgwick is hiring a Claims Examiner - Workers Compensation to adjudicate complex workers compensation claims on behalf of clients. The role emphasizes analytics, timely adjudication, and excellent customer service.

Licensing in CA or NV is required, with a strong background in claims management and ongoing professional development opportunities. Work arrangements offer remote flexibility while maintaining high service standards.

Qualifications

• 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.

Responsibilities

• Analyzing and processing claims through well-developed action plans to a timely resolution by investigating and gathering information to determine 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 directions in a professional and timely manner.

Skills

Claims management

Negotiation

Communication

Problem solving

Education

High school diploma

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 | Jurisdiction: CA or NV | Licensing: required

Are you lookingfor 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 examinerknowledge 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.

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.

PRIMARY PURPOSE OF THE ROLE Toanalyzeworkers compensationclaims 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 requestsofdirections in a professional and timely manner.

QUALIFICATIONS

Education & Licensing: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.

Experience:5 years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge:Must be licensed in California or Nevada

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.

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

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(80k-100k). A comprehensive benefits package is offeredincludingbut 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.

#claimsexaminer#claims#LI-REMOTE

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.