California Workers Compensation Claims Adjuster / Examiner | Remote
Sedgwick•San Bernardino, CA
•$80,000 - $105,000•Remote
About The Position
Sedgwick is hiring a remote California workers' compensation claims professional to analyze complex or technically difficult claims, including high-exposure claims involving litigation and rehabilitation. The role determines benefits due, ensures ongoing adjudication in accordance with service expectations, industry best practices, and client requirements, identifies subrogation opportunities, and negotiates settlements. The successful candidate manages claims from investigation through resolution while meeting statutory requirements and service expectations.
Requirements
- Three years of California workers' compensation claims management experience, or an equivalent combination of education and experience.
- California jurisdictional knowledge.
- SIP certification is required or must be obtained within one year of hire.
Nice To Haves
- Bachelor's degree from an accredited college or university.
- Professional certification applicable to the line of business.
- SIP certification is preferred or required depending on client assignment and state of residence.
Responsibilities
- Investigate complex or technically difficult workers' compensation claims, gather information, and determine claim exposure.
- Manage claims through developed action plans to appropriate and timely resolution.
- Negotiate claim settlements within designated authority.
- Calculate and assign timely, appropriate reserves and manage reserve adequacy throughout the life of each claim.
- Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within the designated authority level.
- Prepare required state filings within statutory limits.
- Manage the litigation process and ensure timely and cost-effective claims resolution.
- Report claims to the excess carrier and respond professionally and promptly to requests for directions.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision coverage.
- 401(k) and matching.
- Paid time off (PTO).
- Disability and life insurance.
- Employee assistance program.
- Flexible spending account or health savings account.
- Additional voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
