Workers Compensation Claims Examiner | San Diego or Roseville, CA

Sedgwick • Roseville, CA

9h • Hybrid

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Sedgwick has been recognized as America’s Greatest Workplaces, a National Top Company Certified as a Great Place to Work®, and among Fortune Best Workplaces in Financial Services & Insurance. This role offers an opportunity to join a global industry leader where you can bring your ideas to help solve problems for some of the world’s best brands. You will apply your knowledge and experience to adjudicate complex customer claims in an energetic culture, delivering innovative customer-facing solutions to clients across virtually every industry. Be part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts for learning and sharing insights. Take advantage of professional development opportunities to enhance your performance and career growth. Enjoy flexibility and autonomy in your daily work, location, and career path. Access diverse and comprehensive benefits for your mental, physical, financial, and professional needs. Sedgwick seeks driven individuals who embody its caring counts model and core values: empathy, accountability, collaboration, growth, and inclusion. The primary purpose of this position is to analyze complex or technically difficult workers' compensation claims to determine benefits due, manage high exposure claims involving litigation and rehabilitation, ensure ongoing adjudication of claims within service expectations and industry best practices, and identify subrogation of claims and negotiate settlements.

Requirements

• Five (5) years of claims management experience or equivalent combination of education and experience required.
• SIP required or must be obtained within one (1) year of employment.
• California workers compensation jurisdictional knowledge required.

Nice To Haves

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
• 401k and matching.
• PTO.
• Disability and life insurance.
• Employee assistance.
• Flexible spending or health savings account.
• Other additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 251-500 employees