Sedgwick · 2 days ago
Workers Compensation Claims Examiner| CA Jurisdiction Knowledge Required | 3 Days Remote
United States
Full-time
Remote
Senior Level
$80K/yr - $105K/yr
5+ years expSedgwick is a global industry leader dedicated to providing meaningful support to individuals facing unexpected challenges. The Workers Compensation Claims Examiner will analyze complex claims, negotiate settlements, and ensure timely resolution while maintaining excellent client relationships.
BankingInsuranceRisk Management
Hiring Manager
Amy MacPherson
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
Required
Five (5) years of claims management experience or equivalent combination of education and experience required
California jurisdiction knowledge; SIP required or must be obtained within one (1) year of employment
Preferred
Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
Benefits
Medical
Dental
Vision
401K on day one
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Company
Sedgwick
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersLa Caisse
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chairman & Chief Executive Officer
Kalani Reelitz
Global Chief Financial Officer
Recent News
Morningstar.com
2025-11-10
2025-09-04
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