Remote Workers' Comp Claims Adjuster (CA)

Sedgwick; Sacramento (CA); Hybrid; USD 73,000 - 85,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Comprehensive benefits

Job summary

Sedgwick in California is seeking a Claims Adjuster to analyze mid- and higher-level workers' compensation claims, determine benefits due, and adjudicate within company standards and industry best practices. You’ll identify subrogation potential and negotiate settlements.

We offer flexible work scheduling, development opportunities, and a comprehensive benefits package alongside the chance to grow within a global, values-driven organization.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of California Workers Compensation claims management experience or equivalent.
• California jurisdictional knowledge required; SIP licensing required or must be obtained within one year.

Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Skills

Claims adjudication

Judgment & analysis

Problem solving

Education

Bachelor's degree

Job description

Sedgwick in California is seeking a Claims Adjuster to analyze mid- and higher-level workers' compensation claims, determine benefits due, and adjudicate within company standards and industry best practices. You’ll identify subrogation potential and negotiate settlements.

We offer flexible work scheduling, development opportunities, and a comprehensive benefits package alongside the chance to grow within a global, values-driven organization.