Sedgwick

Claims Examiner- Workers Compensation | Brea, CA (Hybrid)

Sedgwick$85K — $105K *
Finance & Insurance
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree preferred; professional certification is a plus.
  • 5+ years of claims management experience or equivalent education.
  • California jurisdiction knowledge required; must obtain SIP within one year.
  • Strong judgment and problem-solving abilities needed.
  • Ability to handle multiple priorities and stressful situations.

Responsibilities

  • Analyze and process complex workers' compensation claims.
  • Negotiate settlements within designated authority limits.
  • Communicate claim activities with claimants and clients.
  • Report to excess carriers and respond to inquiries in a timely manner.
  • Manage high exposure claims involving litigation and rehabilitation.

Benefits

  • Flexible work schedule.
  • Referral incentive program.
  • Opportunities for career development and promotion.
  • Comprehensive benefits including medical, dental, and vision.
  • 401K available from day one.
Full Job Description
Claims Examiner- Workers Compensation | Brea, CA (Hybrid)

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?  

  • Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. 
  • Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. 
  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. 
  • Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. 
  • Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. 
  • Enjoy flexibility and autonomy in your daily work, your location, and your career path. 
  • Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. 

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

OFFICE LOCATIONS
Brea, CA - Hybrid (2 days onsite)

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. 
  • Negotiating settlement of claims within designated authority. 
  • Communicating claim activity and processing with the claimant and the client. 
  • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

    QUALIFICATIONS

    Education & Licensing
    Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

    Experience
    Five (5) years of claims management experience or equivalent combination of education and experience required.

    • High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
    • Professional certification as applicable to line of business preferred.

    Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of start date.

    TAKING CARE OF YOU

    • Flexible work schedule. 
    • Referral incentive program. 
    • Career development and promotional growth opportunities. 
    • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

    WORK ENVIRONMENT
    When applicable and appropriate, consideration will be given to reasonable accommodations. 

    Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

    Physical: Computer keyboarding, travel as required

    Auditory/Visual: Hearing, vision and talking

    NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

    As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $85,000 - $105,000 per year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

    #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1

    About Sedgwick

    Sedgwick is a global provider of insurance, risk management, and related services. The company was founded in 1969 and is headquartered in Boston, Massachusetts. Sedgwick offers a range of services to clients in various industries, including property and casualty insurance, workers' compensation, and disability management. The company has a team of experienced professionals who work closely with clients to develop customized solutions that meet their specific needs. Sedgwick has a reputation for delivering high-quality service and has been recognized for its excellence in the insurance industry.
    Learn more about Sedgwick
    Size
    10,000 employees
    Industry
    Founded
    1969

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