Workers Compensation Claims Examiner | Concord, CA
About The Position
The Workers Compensation Claims Examiner analyzes workers compensation claims on behalf of clients to determine benefits due and ensures claims are adjudicated in accordance with service expectations, industry best practices, and client service requirements. The role investigates claims, gathers information to determine exposure, develops action plans, and works toward timely and appropriate resolution. It also negotiates settlements within designated authority, communicates claim activity and processing to claimants and clients, reports claims to excess carriers, and responds promptly and professionally to requests for directions. This position is based in Concord, California, with a hybrid schedule requiring two days onsite. The ideal candidate is a seasoned California workers compensation examiner who values strong client partnerships, a reasonable caseload, and a well-managed intake environment. Sedgwick describes its culture as caring and offers flexibility, career development, and comprehensive benefits.
Requirements
- At least 3 years of claims management experience, or an equivalent combination of education and experience.
- High school diploma or GED.
- At least 3 years of California workers compensation jurisdictional knowledge.
- SIP certification is required or must be obtained within one year of employment.
- Ability to think clearly and conceptually; exercise sound judgment, troubleshooting, problem-solving, analysis, and discretion; handle work-related stress and 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.
Responsibilities
- Analyze and process claims through developed action plans toward appropriate and timely resolution.
- Investigate claims and gather information to determine claim exposure.
- Negotiate claim settlements within designated authority.
- Communicate claim activity and processing with claimants and clients.
- Report claims to the excess carrier and respond professionally and promptly to requests for directions.
- Ensure ongoing claim adjudication meets service expectations, industry best practices, and client service requirements.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision insurance.
- 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
Education Level
High school or GED
