Workers Compensation Claims Examiner

🔥 15 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $85k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 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 and gather information to determine claim exposure • Manage claims through action plans to appropriate and timely 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 claim payments and adjustments • Settle claims within designated authority levels • Prepare necessary state filings within statutory limits • Manage the litigation process and ensure timely, cost-effective claims resolution • Report claims to the excess carrier and respond to requests for direction • Identify subrogation of claims and negotiate settlements

🎯 Requirements

• Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • 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 • Experience handling litigated and high-exposure claims • Ability to manage claims through investigation, benefit determination, settlement negotiation, and resolution • 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 ability • Hearing, vision, and talking abilities

🏖️ Benefits

• Flexible work schedule • Referral incentive program • Career development and promotional growth opportunities • Medical, dental, and vision coverage • 401(k) and matching • Paid time off (PTO) • Disability and life insurance • Employee assistance program • Flexible spending account or health savings account • Other additional voluntary benefits • Reasonable accommodations when applicable and appropriate