Remote Workers' Compensation Claims Examiner (California)

About the role

Sedgwick is hiring a Workers' Compensation Claims Examiner for California, working remotely or hybrid. The role analyzes complex or technically difficult California workers' compensation claims to determine benefits due, works with high-exposure claims involving litigation and rehabilitation, keeps claims adjudicated within service expectations and client requirements, identifies subrogation and negotiates settlements. Candidates must live in California.

Key responsibilities

• Analyze and process complex claims by investigating and gathering information to determine exposure, then manage them through action plans to timely resolution.
• Negotiate settlements within designated authority.
• Calculate and assign reserves, manage reserve adequacy throughout the claim's life, calculate and pay benefits, approve payments and adjustments, and settle claims within authority.
• Prepare state filings within statutory limits and manage the litigation process in a timely, cost-effective way.
• Report claims to the excess carrier and respond to requests for directions professionally and on time.

Required profile

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

Required skills

• Computer keyboarding.
• Problem-solving, analysis, judgment and discretion, with the ability to handle stress, multiple priorities and meet deadlines.

What we offer

• Flexible work schedule and referral incentive program.
• Career development and promotion opportunities.
• Medical, dental and vision coverage, 401K on day one, PTO, disability and life insurance, and other voluntary benefits.
• Starting pay range of $80,000 - $105,000 for this California role.