Sedgwick is seeking a Workers Compensation Claims Examiner to join our dedicated account team. In this role, you will analyze complex or technically difficult workers' compensation claims to determine benefits due, focusing on high-exposure claims involving litigation and rehabilitation to ensure proper adjudication.
What You'll Do
- Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely, appropriate reserves and manage reserve adequacy throughout the claim lifecycle.
- Calculate and pay benefits due; approve and make timely claim payments and adjustments.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process to ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and litigation management.
- Use cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and offsets.
- Report claims to excess carriers and respond professionally to requests.
- Communicate claim activity with claimants and clients, maintaining professional relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
What We're Looking For
- Five (5) years of claims management experience or an equivalent combination of education and experience.
- California jurisdictional knowledge is required.
- SIP certification required or must be obtained within one (1) year of employment.
Nice to Have
- Bachelor's degree from an accredited college or university.
- Professional certification as applicable to line of business.
Benefits & Compensation
- Compensation range: $80,000 - $100,000.
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Diverse and comprehensive benefits including medical, dental, vision, and 401K on day one.
Work Mode
This is a hybrid position based in Rancho Cordova, CA, with three (3) days remote per week.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
