Claims Examiner - Workers Compensation | Dedicated Client

Sedgwick • Long Beach, CA

4d

About The Position

The Claims Examiner analyzes complex or technically difficult California workers’ compensation claims to determine benefits due. The role handles high-exposure claims involving litigation and rehabilitation, ensures claims are adjudicated according to service expectations, industry best practices, and client requirements, and identifies subrogation opportunities and negotiates settlements.

The examiner investigates claims, develops action plans for timely resolution, manages reserves and benefit payments, prepares required state filings, oversees litigation, and reports claims to excess carriers. The role is based in Roseville or Long Beach, California. A bachelor’s degree and relevant professional certification are preferred; four years of California workers’ compensation claims management experience or an equivalent combination of education and experience is required. California jurisdictional knowledge is required, and an SIP credential must be held or obtained within one year of hire.

Requirements

• Four years of California workers’ compensation claims management experience, or an equivalent combination of education and experience.
• California jurisdictional knowledge.
• SIP credential required, or must be obtained within one year of hire.
• Clear and conceptual thinking, sound judgment, troubleshooting, problem-solving, analysis, and discretion.
• Ability to handle work-related stress, manage multiple priorities, and meet deadlines.
• Ability to perform computer keyboarding and meet auditory and visual requirements, including hearing, vision, and talking.

Nice To Haves

• Bachelor’s degree from an accredited college or university.
• Professional certification applicable to the line of business.
• Experience handling litigated and high-exposure claims.

Responsibilities

• Investigate and gather information to assess exposure on complex or technically difficult workers’ compensation claims.
• Manage claims using well-developed action plans through 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 designated authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process to support timely and cost-effective claims resolution.
• Report claims to the excess carrier and respond professionally and promptly to requests for direction.
• Identify subrogation opportunities.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level