Complex Claims Advisor | Workers Compensation California Expert | OSIPLicensing| Litigation Strateg

Sedgwick; Sacramento (CA); Hybrid; USD 95,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional op‑

Wide benefits: medical, dental, vision

401K on day one

Job summary

Sedgwick is seeking a California expert Complex Claims Advisor to adjudicate intricate workers’ compensation claims. You’ll apply jurisdictional knowledge, guide the complex claims team, and leverage a broad network to deliver optimal resolutions and robust quality improvement.

The role emphasizes OSIP licensing, litigation strategy, and collaborative leadership across multiple jurisdictions. A flexible schedule and comprehensive benefits accompany a hybrid work arrangement.

Qualifications

• Bachelor's degree preferred.
• Licenses as required for specific jurisdictions.

Responsibilities

• Oversee a complex claim inventory and guide resolution.
• Support claims team as subject matter expert across lines of business and jurisdictions.
• Evaluate exposure and direct action plans for resolution.
• Document clear file notes for stakeholders.
• Lead roundtables and coordinate internal/external resources.
• Provide technical leadership on complex claims and quality improvement.
• Contribute to policy and procedure development.
• Mentor complex claim consultants and team leads.
• Lead calibration exercises to ensure consistency.

Skills

jurisdictional expertise

complex claims adjudication

mentoring and leadership

Education

Bachelor's degree

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 CompaniesCertified as a Great Place to Work®Fortune Best Workplaces in Financial Services & InsuranceComplex 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 Location

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

• 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

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.

Work Environment Requirements

• 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). 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.

#claimsexaminer #claims #hybrid #LI-REMOTE

Legal and Equal Opportunity Statements

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.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway!

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.