Complex Claims Advisor | Workers Compensation California Expert | OSIP Licensing | Litigation Strategy & Resolution

Sedgwick Claims Management Services Ltd; United States; Hybrid; USD 95,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional增长

Medical, dental, vision, 401K and more

PTO and life insurance

Job summary

Sedgwick is seeking a Complex Claims Advisor to adjudicate highly complex workers’ compensation claims and provide expert guidance to a specialized claims team. You will influence strategies, document findings, and drive consistent, high-quality resolutions for stakeholders across multiple jurisdictions.

The role offers a hybrid work model with flexible scheduling, professional development opportunities, and a comprehensive benefits package, including medical, dental, vision, and retirement

Qualifications

• Bachelor’s degree in a related field is preferred.
• Industry designation(s) and OSIP certification are valued.
• Licenses as required for specific jurisdictions including OSIP for CA.

Responsibilities

• Oversee a complex claim inventory, using jurisdictional expertise to guide handling.
• Support claims team as subject matter expert across lines of business and key jurisdictions.
• Evaluate exposure and direct action plans for issue resolution.
• Document clear notes for stakeholders and coordinate roundtables and resources.
• Provide technical leadership and co-own complex claim issues for quality improvement.
• Mentor complex claim consultants, adjusters and team leads; contribute to policy development.

Skills

Complex claims handling

Jurisdictional expertise

Mentoring & leadership

Education

Bachelor's degree

OSIP Certification

Licenses for jurisdictions

California OSIP expert

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 Complex Claims Advisor | Workers Compensation California Expert | OSIP Licensing | Litigation Strategy & Resolution 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.

Work Locations

PRIMARY PURPOSE OF THE ROLE To act as a department subject matter expert by providing guidance to the complex claims team to ensure consistency resolving matters optimally while creating a culture of continual quality improvement destined to elevate the overall claim handling to benefit our stakeholders; to ensure the consistency in the developed targeted solutions, and technical guidance and oversight provided to claims team.

Essential Responsibilities MAY INCLUDE

• Proactively and strategically oversee a complex claim inventory by assessing highly complex claims issues, utilizing jurisdictional expertise, providing oversight, and helping direct the handling to achieve the best possible resolution.
• Assists the claims team as their subject matter expert to assist in addition to lines of business and key jurisdictions on complex claim issues.
• Uses knowledge of all aspects of claims handling in evaluating exposure; recommends and directs action plans for issue or case resolution.
• Articulates and documents clear and concise file notes to allow stakeholders to understand the issues and path to resolution.
• Facilitates roundtables with groups/teams; engages appropriate internal and external resources as needed.
• Provides technical leadership on and maintains co-ownership of complex claim issues; creates a culture of continual quality improvement through further influence.
• Assists in the evaluation and development of policies and procedures.
• Mentors and provides guidance to the complex claim consultants, adjusters and team leads.
• Leads calibration exercises ensuring consistency through the exchange of ideas and strategies.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Industry designation(s) preferred.
• Licenses as required for specific jurisdictions.
• California expert with OSIP Certification.
• Also specializing in litigation strategy and resolution Licensing: OSIP TAKING CARE OF YOU

Benefits

• 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.

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 (95k - 100K).

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

You may be just the right candidate for this or other roles.

#claimsexaminer #claims #hybrid #LI-REMOTE

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