Sedgwick is seeking a Workers Compensation Claims Examiner to join our team. In this hybrid role based in West Hills, CA, you will be responsible for analyzing complex or technically difficult workers' compensation claims to determine benefits due. You will manage high exposure claims involving litigation and rehabilitation, ensuring adjudication aligns with service expectations and industry best practices. At Sedgwick, we foster a caring culture built on empathy, accountability, collaboration, growth, and inclusion.
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 and appropriate reserves; manage reserve adequacy throughout the life of the claim.
- 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 appropriate cost containment techniques, including strategic vendor partnerships.
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and offsets.
- Report claims to the excess carrier and respond to requests professionally and promptly.
- Communicate claim activity with the claimant and client, maintaining professional 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.
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 - $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 option to work remotely 3 days per week.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
