Workers Compensation Claims Adjuster | Brea, CA

Sedgwick•Brea, CA

2d•$73,000 - $85,000

About The Position

The Workers Compensation Claims Adjuster analyzes mid- and higher-level workers compensation claims to determine benefits due, ensure ongoing adjudication within company standards and industry best practices, identify subrogation opportunities, and negotiate settlements. The role manages long-term indemnity claims, claim action plans, payments, documentation, and return-to-work efforts, while communicating with claimants and clients and maintaining professional client relationships. It may also involve complex lifetime medical or defined-period medical claims, including state and physician filings and decisions about treatments recommended by utilization review. The position is based in Brea, California; the posting includes a hybrid and remote hashtag but does not specify a workplace arrangement.

Requirements

Three years of California workers compensation claims management experience, or an equivalent combination of education and experience.
California jurisdictional knowledge is required.
SIP is required or must be obtained within one year of employment.
Ability to think clearly and conceptually, exercise excellent judgment and discretion, troubleshoot, solve problems, analyze information, handle work-related stress and multiple priorities, and meet deadlines.
Ability to perform computer keyboarding and to hear, see, and talk.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.

Responsibilities

Manage workers compensation claims, determine compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file required documentation with state agencies.
Develop and manage workers compensation claim action plans through resolution, coordinate return-to-work efforts, and approve claim payments.
Approve and process assigned claims, determine benefits due, and manage action plans in accordance with the claim or client contract.
Manage claim subrogation and negotiate settlements.
Communicate claim actions to claimants and clients.
Ensure claim files are properly documented and claims coding is correct.
May process complex lifetime medical or defined-period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintain professional client relationships.
Perform other duties as assigned.
Support the organization's quality programs.
Travel as required.