Claims Examiner, Workers Compensation I

🕒 April 14

🏄 California – Remote

🏄 California – Remote

💵 $63.4k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 35%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 complex or technically difficult workers' compensation claims to determine benefits due • Work with high exposure claims involving litigation and rehabilitation • Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements • Identify subrogation of claims and negotiate settlements • 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 • 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 • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships

🎯 Requirements

• 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 • Subject matter expert of appropriate insurance principles and laws for line-of-business handled • Excellent oral and written communication, including presentation skills • PC literate, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Good interpersonal skills • Excellent negotiation skills • Ability to work in a team environment • Ability to meet or exceed Service Expectations

🏖️ Benefits

• medical • dental • vision • 401k and matching • PTO • disability and life insurance • employee assistance • flexible spending or health savings account • other additional voluntary benefits

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