Workers Compensation Claims Examiner

🔥 12 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 complex or technically difficult California workers' compensation claims to determine benefits due • 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 and ensure timely, cost-effective claims resolution • Report claims to the excess carrier and respond to requests for directions • Identify claim subrogation and negotiate settlements • Deliver customer-facing solutions and collaborate with clients and global experts

🎯 Requirements

• California workers' compensation experience • Four (4) years of California workers' compensation claims management experience, or equivalent combination of education and experience • Experience handling litigated and high-exposure claims • Understanding of California jurisdictional requirements • Experience managing claims through investigation, benefit determination, settlement negotiation, and resolution • Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • California jurisdictional knowledge required • SIP required or must be obtained within one year of hire date • Ability to analyze complex or technically difficult workers' compensation claims • Ability to investigate and gather claim exposure information • Ability to calculate and assign reserves and benefits • Ability to manage litigation processes • Ability to prepare necessary state filings within statutory limits • 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 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 • Flexible location and autonomy in daily work