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Sedgwick · 2 weeks ago

Workers Compensation Claims Examiner | Roseville or San Diego, CA | 3 Days Remote

United States

Full-time

Remote

Mid, Senior Level

$80K/yr - $100K/yr

5+ years exp

Sedgwick is a global industry leader known for its excellence and customer service. The Workers Compensation Claims Examiner will analyze complex claims, negotiate settlements, and ensure timely resolution while maintaining professional relationships with clients and claimants.

BankingInsuranceRisk Management

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 claims 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

Claims management experienceCalifornia workers compensation knowledgeProfessional certificationNegotiation skillsEmpathyAccountabilityInclusionCollaborationGrowth

Required

Bachelor's degree from an accredited college or university preferred

Five (5) years of claims management experience or equivalent combination of education and experience required

SIP required or must be obtained within one (1) year of employment

California workers compensation jurisdictional knowledge required

Preferred

Professional certification as applicable to line of business preferred

Benefits

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.

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.