Hybrid Workers’ Compensation Claims Examiner

Sedgwick Claims Management Services Ltd; Cameron Park (CA); Hybrid; USD 72,000 - 88,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) with matching

PTO

Flexible spending or HSA

Job summary

Sedgwick is seeking a Claims Examiner for Workers' Compensation to analyze and adjudicate claims for clients across California. The role follows a hybrid model with 2 days in the office and 3 days work-from-home, supporting California and Oregon Sedgwick offices.

You will determine benefits due and ensure ongoing adjudication within service expectations and client requirements, leveraging a broad network and comprehensive benefits. A strong claims-management background is essential.

Qualifications

• High School Diploma or GED required. Bachelor's degree preferred. Professional certification as applicable to line of business is a plus.
• 5 years of claims management experience or equivalent combination of education and experience required.
• Licensing/Jurisdiction knowledge: CA required.

Responsibilities

• Analyzing and processing claims through developed action plans to an appropriate and timely resolution.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a timely manner.

Skills

Claims handling

Negotiation

Communication

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is seeking a Claims Examiner for Workers' Compensation to analyze and adjudicate claims for clients across California. The role follows a hybrid model with 2 days in the office and 3 days work-from-home, supporting California and Oregon Sedgwick offices.

You will determine benefits due and ensure ongoing adjudication within service expectations and client requirements, leveraging a broad network and comprehensive benefits. A strong claims-management background is essential.