Claims Examiner - Workers Compensation (CA)

About the role

Sedgwick is hiring a Claims Examiner for California workers' compensation claims, based in San Diego. 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 workers' compensation claims by investigating and gathering information to determine exposure, then manage them through action plans to timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign reserves, manage reserve adequacy throughout the life of the claim, calculate and pay benefits, approve payments and adjustments, and settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process and report claims to the excess carrier, responding to requests for direction.

Required profile

• Bachelor's degree from an accredited college or university preferred; professional certification for the line of business preferred.
• Four years of California workers' compensation claims management experience, or an equivalent combination of education and experience.
• California jurisdictional knowledge required; SIP required or must be obtained within one year of hire.
• Experience handling litigated and high-exposure claims, understanding California jurisdictional requirements, and managing claims through investigation, benefit determination, settlement negotiation and resolution.

What we offer

• Flexible work schedule, referral incentive program and career development opportunities.
• Medical, dental, vision, 401K on day one, PTO, disability and life insurance, and other benefits.
• Starting pay range of $80,000 - $100,000 for this role.