Workers Compensation Claims Examiner (Hybrid)

About the role

Sedgwick is hiring a Workers Compensation Claims Examiner in Orange, CA, working in a hybrid setting. The role analyzes complex or technically difficult workers' compensation 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 to determine exposure, then manage them through action plans to a 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 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 claimants and clients, document files correctly and refer cases to supervisors and management when needed.

Required profile

• 5 years of claims management experience or an equivalent combination of education and experience.
• High school diploma or GED; bachelor's degree preferred.
• California workers' compensation claims handling experience; SIP certification preferred.
• Professional certification for the line of business preferred.

Required skills

• Computer keyboarding.
• Clear conceptual thinking, judgment, problem-solving and analysis, with the ability to handle stress, multiple priorities and deadlines.

What we offer

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