Remote CA Workers' Compensation Claims Examiner

Sedgwick; California; Hybride; USD 80 000 - 105 000; Plein temps

Avantages offerts par ce poste

Flexible work schedule

Referral incentive program

Career development and promotional成长

Résumé du poste

Sedgwick in California is seeking an experienced Remote Workers' Compensation Claims Examiner to analyze complex claims, including litigated and high-exposure cases, and to determine benefits with a focus on timely adjudication and subrogation where applicable.

The ideal candidate has California WC claims management experience, SIP certification (preferred/required depending on client), and a strong commitment to service quality, accuracy, and regulatory compliance.

Qualifications

• California workers' compensation claims management experience.
• Bachelor's degree from an accredited college or university preferred.
• California jurisdictional knowledge required; SIP certification preferred or must be obtained within one year of hire date.

Responsabilités

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

Connaissances

California WC claims experience

SIP certification

California jurisdiction knowledge

Formation

Bachelor's degree

Professional certification as applicable to line of business

Description du poste

Sedgwick in California is seeking an experienced Remote Workers' Compensation Claims Examiner to analyze complex claims, including litigated and high-exposure cases, and to determine benefits with a focus on timely adjudication and subrogation where applicable.

The ideal candidate has California WC claims management experience, SIP certification (preferred/required depending on client), and a strong commitment to service quality, accuracy, and regulatory compliance.