Workers Compensation Claims Examiner - CA | On-Site or Remote
About The Position
Sedgwick is hiring a California Workers Compensation Claims Examiner to analyze workers compensation claims for clients, determine benefits due, and ensure claims are adjudicated in accordance with service expectations, industry best practices, and client-specific requirements. The role involves investigating claims, assessing exposure, developing action plans, and bringing claims to timely and appropriate resolution. The examiner also negotiates settlements within designated authority, communicates claim activity with claimants and clients, and reports claims to excess carriers while responding to requests for direction. The position may be based at Sedgwick offices in Riverside, Ontario, or Roseville, California; other California locations and remote options may be available. The role is suited to an experienced California workers compensation examiner who values strong client partnerships and a reasonable caseload in a well-managed intake environment.
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.
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 using developed action plans to achieve appropriate and timely resolution.
- Investigate 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 excess carriers and respond to requests for direction professionally and promptly.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision benefits, and 401(k) available on day one.
- 401(k) 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
