Remote CA Workers' Comp Claims Adjuster

Sedgwick; San Diego (CA); Hybrid; USD 73,000 - 85,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Job summary

Sedgwick, a global leader in risk and claims management, is hiring a Workers' Compensation Claims Adjuster in California. You will analyze mid- to high-level workers compensation claims to determine benefits, ensure adjudication in line with company standards, and identify subrogation opportunities.

The role requires CA claims experience and jurisdictional knowledge, with flexibility for a hybrid work arrangement in CA.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
• 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.

Skills

Claims management

Education

Bachelor's degree preferred

Job description

Sedgwick, a global leader in risk and claims management, is hiring a Workers' Compensation Claims Adjuster in California. You will analyze mid- to high-level workers compensation claims to determine benefits, ensure adjudication in line with company standards, and identify subrogation opportunities.

The role requires CA claims experience and jurisdictional knowledge, with flexibility for a hybrid work arrangement in CA.