Claims Examiner - Workers Comp (Hybrid, Roseville, CA)

About the role

Sedgwick is hiring a hybrid Claims Examiner for its Workers' Compensation unit in Roseville, California. The role analyzes complex or technically difficult claims to determine benefits due, works with high-exposure claims involving litigation and rehabilitation, keeps adjudication within service expectations and client requirements, identifies subrogation and negotiates settlements.

Key responsibilities

• Analyze and process complex claims by investigating and gathering information, then manage them through action plans to timely resolution
• Negotiate settlements within designated authority
• Calculate and assign reserves, calculate and pay benefits, approve payments and adjustments, and settle claims within authority
• Prepare state filings within statutory limits and manage the litigation process
• Coordinate vendor referrals, use cost-containment techniques and manage claim recoveries such as subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
• Report claims to the excess carrier, communicate with claimants and clients, and keep files properly documented with correct coding
• Refer cases to supervisors and management as appropriate, support the quality program and travel as required

Required profile

• Bachelor's degree from an accredited college or university preferred; professional certification for the line of business preferred
• Five years of claims management experience or an equivalent combination of education and experience
• Credit security clearance confirmed by a background credit check is required

Required skills

• Subject-matter expertise in insurance principles and laws, recoveries, offsets and deductions, claim and disability duration, cost containment and medical management, and Social Security and Medicare procedures
• Microsoft Office and PC literacy
• Excellent oral and written communication, negotiation and interpersonal skills, analytical and organizational abilities

What we offer

• Starting pay range of $80-85K for this role
• Medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, and flexible spending or health savings accounts