Hybrid Claims Examiner, Workers' Compensation

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

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.