Workers Compensation - Claims Adjuster | HYBRID | Riverside, CA

Sedgwick; Riverside (CA); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Sedgwick in Riverside, CA is seeking a Hybrid Workers' Compensation Claims Adjuster to analyze mid- to high-level claims and determine benefits due, while ensuring adjudication aligns with company standards and industry best practices. Responsibilities include developing action plans, coordinating return-to-work, and managing subrogation and settlements.

The role requires 3 years of claims management experience, a CA workers' comp background, and a preferred Bachelor's degree.

Qualifications

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

Responsibilities

• Analyzes mid- and higher-level workers compensation claims to determine benefits due and ensure ongoing adjudication within company standards.
• Develops and manages claims action plans to resolution and coordinates return-to-work efforts.
• Approves and processes assigned claims, determines benefits due, and manages action plans per the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim actions with the 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 with state and physician filings.

Skills

Claims management

California workers' compensation

Education preferred

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 | Riverside, CA
OFFICE LOCATION: Riverside, CA (3 days In Office/2 days WFH)
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.

QualificationsEducation & 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 ENVIRONMENTWhen 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 - $85,000/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.
#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.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.