Sedgwick is looking for a Workers Compensation Claims Examiner to join our team. In this role, you will analyze complex or technically difficult claims to determine benefits due, managing high-exposure cases involving litigation and rehabilitation. You'll ensure ongoing adjudication aligns with service expectations and industry best practices within our caring, collaborative culture.

What You'll Do

Analyze and process complex or technically difficult 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 your designated authority.
Calculate and assign timely and appropriate reserves to claims and manage reserve adequacy throughout the claim's life.
Calculate and pay benefits due, approve timely claim payments and adjustments, and settle claims within your authority level.
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 Social Security and Medicare offsets.
Report claims to the excess carrier and respond to requests for directions professionally and timely.
Communicate claim activity and processing with the claimant and client, maintaining professional client relationships.
Ensure claim files are properly documented and claims coding is correct.
Refer cases as appropriate to supervisor and management.
Support the organization's quality programs.
Travel as required.

What We're Looking For

Five (5) years of claims management experience or an equivalent combination of education and experience.
Subject matter expertise of appropriate insurance principles and laws for this line of business.
Knowledge of recoveries offsets and deductions, claim and disability duration, and cost containment principles including medical management practices and Social Security and Medicare application procedures.
Excellent oral and written communication, including presentation skills.
PC literacy, including proficiency with Microsoft Office products.
Analytical and interpretive skills.
Strong organizational and good interpersonal skills.
Excellent negotiation skills.
Ability to work in a team environment and meet or exceed Service Expectations.
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion.
Ability to handle work-related stress and multiple priorities simultaneously and meet deadlines.
Credit security clearance, confirmed via a background credit check.

Nice to Have

Bachelor's degree from an accredited college or university.
Professional certification as applicable to the line of business.

Technical Stack

Microsoft Office

Benefits & Compensation

Compensation: $80,000 - $98,000
Medical, dental, and vision insurance
401k and matching
PTO
Disability and life insurance
Employee assistance program
Flexible spending or health savings account
Other additional voluntary benefits

Work Mode

This is a hybrid position based in West Hills, CA, with the flexibility to work remotely 3 days per week.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable fair chance ordinances.