Workers Compensation Claims Examiner

Sedgwick Claims Management Services Ltd; San Diego (CA); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Medical, dental, vision, 401K on day 1

Job summary

Sedgwick is seeking a California Workers' Compensation Claims Examiner to analyze complex claims, determine benefits, and manage settlements with a focus on cost-effective resolutions. The role requires five years of claims management experience and CA-specific knowledge.

Benefits include a flexible work schedule, referral incentives, and a comprehensive package with medical, dental, vision, 401K and more. This position offers hybrid work arrangements and opportunities for career development.

Qualifications

• Bachelor's degree preferred.
• CA jurisdiction knowledge required; SIP certification due within 1 year.

Responsibilities

• Analyze complex workers' compensation claims to determine exposure and benefits.
• Negotiate settlements within designated authority and manage reserves.
• Calculate and pay benefits, and ensure timely claim payments.
• Prepare state filings within statutory limits and manage litigation.
• Coordinate vendor referrals for investigation and/or litigation management.
• Report claim activity to clients and maintain professional relationships.

Skills

Claims adjudication

Negotiation

Analytical thinking

Client communication

CA jurisdiction knowledge

Education

Bachelor's degree

Job description

## Workers Compensation Claims ExaminerBy 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 Work(R)Fortune Best Workplaces in Financial Services & InsuranceWorkers Compensation Claims Examiner* 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.Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well-managed intake environment.**PRIMARY PURPOSE**: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.**ESSENTIAL FUNCTIONS and RESPONSIBILITIES*** Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.* Negotiates settlement of claims within designated authority.* Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.* Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.* Prepares necessary state fillings within statutory limits.* Manages the litigation process; ensures timely and cost effective claims resolution.* Coordinates vendor referrals for additional investigation and/or litigation management.* Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.* Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.* Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.* Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.* Ensures claim files are properly documented and claims coding is correct.* Refers cases as appropriate to supervisor and management.**QUALIFICATION****Education & Licensing**Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.**Experience**Five (5) years of 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 YOU*** Flexible 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.*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 $80,000 - $100,000. 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 #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1Qualified 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.## Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see