Workers Compensation Claims Examiner

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

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional成长

Job summary

Sedgwick in Brea, California, is seeking a Workers' Compensation Claims Examiner to adjudicate mid- to high-level claims and determine benefits due. You will leverage Sedgwick’s network to manage subrogation, settlements, and complex lifetime medical claims where needed.

The role emphasizes timely adjudication, quality documentation, and client communication. A bachelor’s degree is preferred, with 3 years of California WC claims experience and active SIP or the ability to obtain within a year.

Qualifications

• Bachelor's degree preferred.
• Three (3) years of California Workers Compensation claims management experience.
• California jurisdiction knowledge required; SIP required or must be obtained within one (1) year of employment.

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 and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Education

Bachelor's degree from an accredited college or university

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 CompaniesCertified as a Great Place to WorkFortune Best Workplaces in Financial Services & InsuranceWorkers Compensation Claims ExaminerWorkers Compensation - Claims ExaminerAre you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.Enjoy flexibility and autonomy in your daily work, your location, and your career path.Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.OFFICE LOCATION: Brea, CaliforniaPRIMARY 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 RESPONSIBILITIESManages 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 RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).Travels as required.QUALIFICATIONSEducation & LicensingBachelor's degree from an accredited college or university preferred.ExperienceThree (3) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.TAKING CARE OF YOUFlexible work schedule.Referral incentive program.Career development and promotional growth opportunities.A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.WORK ENVIRONMENT REQUIREMENTS INCLUDEWhen 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 deadlinesPhysical: Computer keyboardingAuditory/Visual: Hearing, vision and talkingAs 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 $73,000 - 85,000. 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.#Claims #ClaimsAdjuster #Hybrid #RemoteQualified 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.