Claims Examiner – Workers Compensation, CA Jurisdiction

🔥 4 minutes ago

🌵 Arizona, California, +4 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🎰 Nevada – Remote 🤠 Texas – Remote ⛷️ Utah – Remote

💵 $80k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Analyze and process complex or technically difficult California workers' compensation claims • Investigate claims and gather information to determine claim exposure • Manage claims through action plans to timely and appropriate resolution • Negotiate claim settlements within designated authority • Calculate and assign timely and appropriate reserves • Manage reserve adequacy throughout the life of claims • Calculate and pay benefits due • Approve and make timely claim payments and adjustments • Settle claims within designated authority level • Prepare necessary state filings within statutory limits • Manage litigation processes for timely and cost-effective claims resolution • Report claims to the excess carrier • Respond to requests for direction professionally and promptly • Identify subrogation claims and negotiate settlements

🎯 Requirements

• California workers' compensation claims experience • Experience handling litigated and high-exposure claims • Four (4) years of California workers compensation claims management experience or equivalent combination of education and experience required • California jurisdictional knowledge required • SIP required or must be obtained within one year of hire date • Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • Ability to investigate claims and gather information to determine exposure • Ability to manage claims through investigation, benefit determination, settlement negotiation, and resolution • Ability to calculate and assign reserves • Ability to calculate and pay benefits and make claim payments and adjustments • Ability to prepare necessary state filings within statutory limits • Ability to manage litigation processes • Ability to report claims to excess carriers and respond to requests for direction • Clear and conceptual thinking ability • Excellent judgment, troubleshooting, problem solving, analysis, and discretion • Ability to handle work-related stress and multiple priorities simultaneously • Ability to meet deadlines • Computer keyboarding • Hearing, vision, and talking

🏖️ Benefits

• Flexible work schedule • Referral incentive program • Career development and promotional growth opportunities • Medical, dental, and vision insurance • 401K and matching • PTO • Disability and life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Flexibility and autonomy in daily work, location, and career path • Professional development opportunities