Remote CA Workers' Comp Claims Examiner

Sedgwick; Austin (TX); Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) on day one

Flexible work schedule

Job summary

Sedgwick is seeking a claims examiner with California workers' compensation experience to adjudicate complex claims, manage litigation, and drive timely resolutions in a largely remote role. You will determine benefits, set reserves, and coordinate with clients across diverse industries while upholding service standards.

The ideal candidate has strong negotiation skills, lodging appropriate state filings, and familiarity with California jurisdictional requirements.

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.
• Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.

Responsibilities

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Skills

CA workers' compensation experience

Litigation handling

Claims investigations

Negotiation

Education

Bachelor's degree

Job description

Sedgwick is seeking a claims examiner with California workers' compensation experience to adjudicate complex claims, manage litigation, and drive timely resolutions in a largely remote role. You will determine benefits, set reserves, and coordinate with clients across diverse industries while upholding service standards.

The ideal candidate has strong negotiation skills, lodging appropriate state filings, and familiarity with California jurisdictional requirements.