Remote CA Workers' Comp Claims Examiner

Sedgwick; Denver (CO); Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Medical, dental, vision, 401K on day 1

Job summary

Sedgwick is seeking a CA Workers’ Compensation Claims Examiner to adjudicate complex claims, including litigated and high-exposure cases. You will work within California jurisdiction guidelines, manage investigations, settlements, and subrogation, and liaise with clients to provide strong service.

The role emphasizes investigation, accuracy, and timely resolutions with a focus on client requirements and national flexibility for telecommute options.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four years of California workers' compensation claims management experience or equivalent combination of education and experience required.
• California jurisdiction 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

Claims adjudication

Litigation handling

Settlement negotiation

Subrogation awareness

Customer service

Education

Bachelor's degree

Professional certification

Job description

Sedgwick is seeking a CA Workers’ Compensation Claims Examiner to adjudicate complex claims, including litigated and high-exposure cases. You will work within California jurisdiction guidelines, manage investigations, settlements, and subrogation, and liaise with clients to provide strong service.

The role emphasizes investigation, accuracy, and timely resolutions with a focus on client requirements and national flexibility for telecommute options.