Claims Examiner - Workers Compensation | CA WC Experience Required

Sedgwick; California (MO); On-site; USD 80,000 - 105,000; Full time

Job summary

Sedgwick is hiring a Workers’ Compensation Claims Examiner to analyze and adjudicate California workers’ compensation claims with high exposure, including litigation and rehabilitation considerations.

The role requires doing complex investigations, negotiating settlements, and ensuring timely payments and filings while meeting client service requirements and regulatory standards in California.

Qualifications

• Bachelor's degree from an accredited college or university preferred; professional certification in line of business preferred.
• Four (4) years of workers' compensation claims management experience or equivalent combination of education and experience required.
• California jurisdiction knowledge required; SIP required or must be obtained within one year of hire date.

Responsibilities

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine exposure and resolve.
• Negotiate settlement of claims within designated authority.
• Calculate and assign reserves; manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost-efficient claims resolution.
• Report claims to the excess carrier and respond to requests of direction professionally and promptly.

Education

Bachelor's degree

Professional certification (line of business)

Job description

Job Title

Workers Compensation Claims Examiner

Primary Purpose of the Role

To analyze complex or technically difficult California 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.

Work Location

Must reside in California.

Essential Responsibilities

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost‑effective claims resolution.
• Report claims to the excess carrier and respond to requests of direction in a professional and timely manner.

Required Qualifications

• Education: Bachelor's degree from an accredited college or university preferred; professional certification in line of business preferred.
• Experience: Four (4) years of workers' compensation claims management experience or equivalent combination of education and experience required.
• Licensing / Jurisdictional Knowledge: California jurisdiction knowledge required; SIP required or must be obtained within one year of hire date.

Compensation and Benefits

Starting pay range: $80,000 - $105,000. A comprehensive benefits package is offered including medical, dental, vision, 401(k) with matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Equal Opportunity Employer

Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable Fair Chance laws and ordinances, including the Los Angeles County Fair Chance Ordinance, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, and the California Fair Chance Act.