Remote California Workers' Comp Claims Examiner

Sedgwick Claims Management Services Ltd; San Diego (CA); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Job summary

Sedgwick is seeking a Claims Examiner to analyze complex California workers' compensation claims and determine benefits due. You will handle high exposure cases, manage litigation, settlements, and reserves, and ensure timely adjudication aligned with client requirements.

The role involves reporting to the claims leadership, coordinating with counsel, and leveraging Sedgwick's resources to navigate subrogation and cost-effective resolutions while maintaining compliance and service standards.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business 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 year of hire date.

Responsibilities

• Analyzes and processes complex or technically difficult 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 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 analysis

Regulatory knowledge

Negotiation

Litigation coordination

Education

Bachelor's degree

Job description

Sedgwick is seeking a Claims Examiner to analyze complex California workers' compensation claims and determine benefits due. You will handle high exposure cases, manage litigation, settlements, and reserves, and ensure timely adjudication aligned with client requirements.

The role involves reporting to the claims leadership, coordinating with counsel, and leveraging Sedgwick's resources to navigate subrogation and cost-effective resolutions while maintaining compliance and service standards.