Hybrid: Workers' Compensation Claims Specialist

Sedgwick Claims Management Services Ltd; Orange (CA); Hybrid; USD 73,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Career development

Benefits package

Job summary

Sedgwick is seeking a claims professional to adjudicate mid- to high-level California workers' compensation claims, determining benefits and monitoring adjudication to company standards. The role emphasizes subrogation, settlements, and ensuring accurate documentation and coding for complex medical claims.

Ideal candidates have a California claims background, four years of experience, and a Bachelor's degree.

Qualifications

• Education: Bachelor's degree from an accredited college or university preferred.
• Experience: Four (4) years of California Workers Compensation claims management experience or equivalent.
• Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.

Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with 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 which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Education

Bachelor's degree

Job description

Sedgwick is seeking a claims professional to adjudicate mid- to high-level California workers' compensation claims, determining benefits and monitoring adjudication to company standards. The role emphasizes subrogation, settlements, and ensuring accurate documentation and coding for complex medical claims.

Ideal candidates have a California claims background, four years of experience, and a Bachelor's degree.