Remote CA Workers' Comp Claims Examiner

Sedgwick Claims Management Services Ltd; United States; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, vision, 401K on day 1

Job summary

Sedgwick Claims Management Services Ltd. seeks an experienced Claims Examiner to adjudicate complex California workers' compensation claims and support high-exposure cases. You will work within an energetic culture to determine benefits due, manage settlements, and coordinate with clients and legal teams.

The role emphasizes analysis, timely action plans, and accurate reserve calculations, with a focus on cost-effective resolution and compliance with statutory requirements.

Qualifications

• Education & Licensing: Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Experience: 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 California 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 filings 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.

Education

Bachelor's degree from accredited college/university

Job description

Sedgwick Claims Management Services Ltd. seeks an experienced Claims Examiner to adjudicate complex California workers' compensation claims and support high-exposure cases. You will work within an energetic culture to determine benefits due, manage settlements, and coordinate with clients and legal teams.

The role emphasizes analysis, timely action plans, and accurate reserve calculations, with a focus on cost-effective resolution and compliance with statutory requirements.