Workers Compensation Claims Examiner I CA experience required

Sedgwick Claims Management Services Ltd; California (MO); Remote; USD 71,000 - 100,000; Full time

Job summary

An established industry player is seeking a Workers Compensation Claims Examiner to join their team. This role involves analyzing complex claims, negotiating settlements, and ensuring timely resolutions. The company prides itself on a culture of caring and offers a supportive environment where employees can thrive. With a focus on diversity and inclusion, this is an opportunity to make a meaningful impact while advancing your career. If you're passionate about helping others and enjoy a challenge, this could be the perfect fit for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k and Matching

PTO

Disability Insurance

Life Insurance

Employee Assistance Program

Flexible Spending Account

Health Savings Account

Qualifications

• 5+ years of claims management experience or equivalent.
• Bachelor's degree preferred, with applicable professional certification.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlements and manage claim reserves effectively.

Skills

Insurance Principles

Claims Management

Negotiation Skills

Analytical Skills

Oral and Written Communication

Organizational Skills

Interpersonal Skills

Education

Bachelor's Degree

Professional Certification

Tools

Microsoft Office

Job description

Global Privacy Policy
Sedgwick’s caring counts commitment is to value the right of privacy of the companies and individuals we serve. It is Sedgwick’s policy to comply with all applicable privacy and data protection laws and maintain the trust of those we serve.

We want to share with you our policy to what personal information we may collect, how we may use this information and other important areas relating to your privacy and data protection. Please find below links to the policies that apply to all internet sites and applications of Sedgwick and its groups of companies.

Workers Compensation Claims Examiner I CA experience required page is loaded

Workers Compensation Claims Examiner I CA experience required

Apply locations Telecommuter CA time type Full time posted on Posted 2 Days Ago job requisition id R60951

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer

Workers Compensation Claims Examiner I CA experience required

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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATION

Education & Licensing
Bachelor'sdegree 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.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

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

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.They are not intended to constitute a comprehensive list of functions, duties, or local variances.Management retains the discretion to add or to change the duties of the position at any time.

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 ($71,136 - $99,500) . 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.

Sedgwickis 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.

Similar Jobs (1)

Workers Compensation Claims Examiner | CA Claims Exp Required

locations Telecommuter CA time type Full time posted on Posted 9 Days Ago