Workers Compensation - Claims Examiner | Orange, CA

Sedgwick Claims Management Services Ltd; Orange (CA); On-site; USD 95,000 - 105,000; Full time

Benefits offered by this job

Referral incentive program

Career development

Comprehensive benefits

Job summary

Sedgwick Claims Management Services Ltd in Orange, CA is seeking a seasoned Workers' Compensation Claims Examiner to analyze claims and determine benefits due, while meeting service expectations. This hybrid role combines autonomous work with collaboration across clients and a supportive team.

You will negotiate settlements within authority, communicate with claimants and clients, and leverage Sedgwick’s network to deliver accurate adjudication and strong client service.

Qualifications

• 3 years of claims management experience or equivalent education and experience.
• High School Diploma or GED required; Bachelor's degree preferred.
• California workers compensation knowledge required; SIP certification within 1 year.

Responsibilities

• Analyze workers compensation claims to determine benefits due.
• Negotiate settlements within designated authority.
• Communicate claim activity with the claimant and the client.
• Report claims to the excess carrier and respond to directions promptly.

Skills

Claims management

California WC knowledge

Negotiation

Analytical thinking

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

## Workers Compensation - Claims Examiner | Orange, CAApply: Orange, CA: Full time: Posted Today: R78671By 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 Examiner | Orange, CAAre 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 workers compensation 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?**Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‐managed intake environment. **OFFICE LOCATION: ORANGE, CA (Hybrid)** **PRIMARY PURPOSE OF THE ROLE:**To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE**· Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.· Negotiating settlement of claims within designated authority.· Communicating claim activity and processing with the claimant and the client.· Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. **QUALIFICATIONS**Education & Licensing: 3 years of claims management experience or equivalent combination of education and experience required. · High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.· Professional certification as applicable to line of business preferred. **Licensing / Jurisdiction Knowledge:**3 or more yearsCalifornia workers compensation 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.Diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.**WORK ENVIRONMENT REQUIREMENTS** **INCLUDE** 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**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 $95-105K. 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.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.