Workers Compensation - Claims Adjuster | HYBRID

Sedgwick; Roseville (CA); Hybrid; USD 65,000 - 80,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with matching

Paid time off

Job summary

Sedgwick is seeking a mid- to senior-level Workers' Compensation Claims Adjuster in a HYBRID environment. You will analyze claims to determine benefits, manage action plans, and coordinate return-to-work efforts while ensuring accurate documentation and settlements in line with client contracts.

Ideal candidates have CA workers' compensation experience and at least three years in claims management, with strong negotiation and communication skills.

Qualifications

• Bachelor's degree preferred.
• Three years of claims management experience required.
• California workers' compensation claims experience required.

Responsibilities

• Analyze mid- to high-level workers' compensation claims to determine benefits.
• Develop and manage action plans, coordinate return-to-work efforts, and approve payments.
• Manage subrogation and negotiate settlements; communicate with claimants and clients.
• Ensure proper documentation and correct claims coding; handle complex medical claims when needed.

Skills

Claims management

Negotiation

Communication

Analytical thinking

Education

Bachelor's degree

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Workers Compensation - Claims Adjuster | HYBRID

PRIMARY PURPOSE:

To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS And 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.

ADDITIONAL FUNCTIONS And RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Qualifications

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Three (3) years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge:

California workers' compensation claims experience required | SIP Preferred

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental:

Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical:

Computer keyboarding, travel as required

Auditory/Visual:

Hearing, vision and talking

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $65,000 - $80,000/yr. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Always accepting applications

#claimsadjuster #claims #hybrid

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.