Workers Compensation Claims Examiner (Dedicated Account, Hybrid)

About the role

Sedgwick is hiring a Workers Compensation Claims Examiner for a dedicated account, working remotely three days per week and in the office two days per week. The role is based in Roseville, CA or San Diego, CA, and involves analyzing complex or technically difficult claims to determine benefits due, handling high-exposure claims involving litigation and rehabilitation, and negotiating settlements.

Key responsibilities

• Analyze and process complex claims by investigating and gathering information to determine exposure, then manage them through action plans to a timely resolution.
• Negotiate settlements within designated authority and calculate and assign reserves, managing reserve adequacy throughout the claim.
• 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.
• Coordinate vendor referrals, use cost-containment techniques such as strategic vendor partnerships, and manage claim recoveries including subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Report claims to the excess carrier, communicate claim activity with the claimant and client, and keep files properly documented with correct coding.

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.
• Knowledge of California jurisdiction required; SIP required or must be obtained within one year of employment.

What we offer

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