Workers’ Comp Claims Specialist — Hybrid/Remote

Sedgwick Claims Management Services Ltd; Orange (CA); On-site; USD 73,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Comprehensive benefits

Career development

Job summary

Sedgwick is seeking a California-based Workers' Compensation Claims Professional to adjudicate mid- to high-level claims and determine benefits due. The role focuses on ongoing adjudication within company standards and subrogation identification, with a strong emphasis on client communication and documentation.

The ideal candidate will have a Bachelor's degree, 4+ years of CA WC claims experience, and be prepared to obtain SIP licensing within a year.

Qualifications

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

Responsibilities

• Manages workers' compensation claims determining compensability and benefits due on long-term indemnity claims.
• Develops and manages action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plans per contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim actions with claimants and clients.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical/defined period medical claims per UR recommendations.
• Maintains professional client relationships.

Education

Bachelor's degree

Job description

Sedgwick is seeking a California-based Workers' Compensation Claims Professional to adjudicate mid- to high-level claims and determine benefits due. The role focuses on ongoing adjudication within company standards and subrogation identification, with a strong emphasis on client communication and documentation.

The ideal candidate will have a Bachelor's degree, 4+ years of CA WC claims experience, and be prepared to obtain SIP licensing within a year.