Apply on Employer Site

Sedgwick · 1 week ago

Workers Compensation Claims Examiner

San Diego, CA

Full-time

Hybrid

Mid, Senior Level

$80K/yr - $100K/yr

5+ years exp

Sedgwick is a global leader in claims management services, and they are seeking a Workers Compensation Claims Examiner to analyze complex claims and ensure timely adjudication. The role involves negotiating settlements, managing litigation processes, and maintaining professional client relationships while leveraging the company's extensive resources.

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 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

California Workers CompensationClaims ManagementNegotiationProfessional CertificationClaims AdjudicationEmpathyAccountabilityInclusionCollaborationGrowth

Required

Five (5) years of California Workers Compensation 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

Bachelor's degree from an accredited college or university 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.