Workers Compensation Claims Examiner

🔥 19 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $80k - $100k / 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 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 reserves and manage reserve adequacy throughout the claim lifecycle • Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority • Prepare necessary state filings within statutory limits • Manage litigation processes for timely and cost-effective resolution • Coordinate vendor referrals for investigation and litigation management • Apply cost containment techniques and strategic vendor partnerships • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets • Report claims to excess carriers and respond to requests for direction • Communicate claim activity and processing with claimants and clients • Maintain professional client relationships • Ensure claim files are documented and claims coding is correct • Refer cases to supervisors and management when appropriate

🎯 Requirements

• Five (5) years of claims management experience or equivalent combination of education and experience required • California jurisdictional knowledge required • SIP required or must be obtained within one (1) year of employment • Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • Ability to analyze and process complex or technically difficult workers' compensation claims • Knowledge of claims investigation, reserves, benefit payments, settlements, litigation, subrogation, recoveries, and cost containment • Ability to prepare necessary state filings within statutory limits • Ability to manage claims and litigation processes • Ability to communicate professionally with claimants and clients • Ability to maintain properly documented claim files and correct claims coding

🏖️ Benefits

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