Hybrid Workers' Comp Claims Adjuster – Settlements & Subro

Sedgwick; Riverside (CA); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Sedgwick in Riverside, CA is seeking a Hybrid Workers' Compensation Claims Adjuster to analyze mid- to high-level claims and determine benefits due, while ensuring adjudication aligns with company standards and industry best practices. Responsibilities include developing action plans, coordinating return-to-work, and managing subrogation and settlements.

The role requires 3 years of claims management experience, a CA workers' comp background, and a preferred Bachelor's degree.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Three (3) years of claims management experience or equivalent combination of education and experience required.
• Licensing / Jurisdiction Knowledge: California workers' compensation claims experience required | SIP Preferred

Responsibilities

• Analyzes mid- and higher-level workers compensation claims to determine benefits due and ensure ongoing adjudication within company standards.
• Develops and manages claims action plans to resolution and coordinates return-to-work efforts.
• Approves and processes assigned claims, determines benefits due, and manages action plans per the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim actions with the claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims with state and physician filings.

Skills

Claims management

California workers' compensation

Education preferred

Education

Bachelor's degree

Job description

Sedgwick in Riverside, CA is seeking a Hybrid Workers' Compensation Claims Adjuster to analyze mid- to high-level claims and determine benefits due, while ensuring adjudication aligns with company standards and industry best practices. Responsibilities include developing action plans, coordinating return-to-work, and managing subrogation and settlements.

The role requires 3 years of claims management experience, a CA workers' comp background, and a preferred Bachelor's degree.