Senior Workers' Comp Claims Specialist

Sedgwick; Ontario (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with employer match

Paid time off

Disability insurance

Life insurance

Employee assistance program

Flexible spending account

Health savings account

Job summary

Sedgwick is seeking a Claims Adjuster for Workers Compensation in Ontario, CA. This role analyzes mid- to high-level workers comp claims, determines benefits, and guides adjudication within company standards and best practices.

Responsibilities include managing claims with respect to compensability, reserves, and subrogation, coordinating return-to-work, and communicating with claimants and clients. Bachelor's degree preferred, 4 years’ claims experience, and strong negotiation skills are

Qualifications

• Bachelor’s degree from an accredited college or university preferred.
• Four (4) years of claims management experience or equivalent required.
• Knowledge of regulations, offsets, disability duration, and medical management.
• Strong written and oral communication skills.
• Proficiency with Microsoft Office and PC literacy.

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 including state/physician filings and decisions on treatments.
• Maintains professional client relationships.

Skills

Regulations knowledge

Communication skills

MS Office

Analytical skills

Organizational skills

Interpersonal skills

Negotiation skills

Teamwork

Service orientation

Education

Bachelor’s degree

Tools

Microsoft Office

Job description

Sedgwick is seeking a Claims Adjuster for Workers Compensation in Ontario, CA. This role analyzes mid- to high-level workers comp claims, determines benefits, and guides adjudication within company standards and best practices.

Responsibilities include managing claims with respect to compensability, reserves, and subrogation, coordinating return-to-work, and communicating with claimants and clients. Bachelor's degree preferred, 4 years’ claims experience, and strong negotiation skills are