Hybrid CA Workers’ Compensation Claims Examiner

Sedgwick; San Diego (CA); Hybrid; USD 80,000 - 100,000; Full time

Job summary

Sedgwick is seeking a seasoned California Workers' Compensation Examiner to adjudicate complex claims, manage high-exposure files, and work within a well‑structured intake environment in a hybrid California setting (Rancho Cordova and San Diego). You will determine benefits due, negotiate settlements, manage reserves, and coordinate with clients and vendors to optimize outcomes.

Ideal candidates have a California jurisdictional knowledge base, a Bachelor's degree, and at least five years of

Qualifications

• Bachelor's degree preferred; professional certification as applicable to line of business preferred.

Responsibilities

• Analyzes and processes complex workers' compensation claims by investigating and gathering information to determine exposure and resolve them.
• Negotiates settlements within designated authority.
• Calculates reserves and ensures reserve adequacy throughout the life of the claim.
• Calculates and pays benefits; approves timely payments and adjustments; settles claims within authority.
• Prepares state filings within statutory limits.
• Manages litigation processes to ensure timely, cost-effective resolutions.
• Coordinates vendor referrals for investigation or litigation.
• Uses cost containment techniques to reduce overall claim costs.
• Manages subrogation, SSA/Medicare offsets, and claim recoveries.
• Reports to excess carriers and maintains professional client relationships.
• Maintains properly documented files and accurate claims coding.

Skills

California jurisdiction knowledge

Education

Bachelor's degree

Job description

Sedgwick is seeking a seasoned California Workers' Compensation Examiner to adjudicate complex claims, manage high-exposure files, and work within a well‑structured intake environment in a hybrid California setting (Rancho Cordova and San Diego). You will determine benefits due, negotiate settlements, manage reserves, and coordinate with clients and vendors to optimize outcomes.

Ideal candidates have a California jurisdictional knowledge base, a Bachelor's degree, and at least five years of