Sedgwick

Claims Examiner - Workers Compensation | Licensing & Jurisdiction: CA - Hybrid

Sedgwick$72K — $95K *
Finance & Insurance
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • High School Diploma or GED required; Bachelor's degree preferred.
  • 5 years of claims management experience or equivalent education and experience required.
  • Professional certification as applicable to line of business preferred.
  • Knowledge of California jurisdiction required.

Responsibilities

  • Analyze and process Workers Compensation claims to determine benefits due.
  • Negotiate settlements of claims within designated authority.
  • Communicate claim activity and processing updates with claimants and clients.
  • Report claims to excess carriers and respond to requests in a timely manner.
  • Develop action plans to resolve claims effectively.

Benefits

  • Flexible work schedule available.
  • Referral incentive program to encourage employee referrals.
  • Opportunities for career development and promotion.
  • Diverse benefits package including medical, dental, and vision coverage available from day one.
Full Job Description
Claims Examiner - Workers Compensation | Licensing & Jurisdiction: 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? 

  • 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.  ​ 

  • 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.  

WORK LOCATIONS: Hybrid 2 days in office, 3 days work from home to all California and Oregon Sedgwick offices.

PRIMARY PURPOSE OF THE ROLETo analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. 

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

  • 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: 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. 

Experience: 5 years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge: CA Required

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 REQUIREMENTSINCLUDE  
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

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 (72k-95k) 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.

#claimsexaminer #claims #hybrid

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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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