Remote Workers Compensation Claims Examiner | CA Jurisdiction
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?
- Open to candidates located in the U.S. with California workers' compensation claims experience.
- SIP certification preferred/required depending on client assignment and state of residence.
ARE YOU AN IDEAL CANDIDATE? We're looking claim's professionals with California workers' compensation experience who enjoy solving complex problems and delivering outstanding service. The ideal candidate has experience handling litigated and high-exposure claims, understands California jurisdictional requirements, and can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.
PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California 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 RESPONSIBLITIES MAY INCLUDE - Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
QUALIFICATIONSEducation & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience: Three (3) years of California workers compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one year of hire 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 REQUIREMENTSINCLUDEWhen 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
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 $80,000 - $105,000. 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 #LI-REMOTE #LI-HYBRID #TPA #insurance #nowhiring #work-at-home #telecommuter
