Workers Compensation Claims Examiner | Roseville, CA
About The Position
Sedgwick is seeking a Workers Compensation Claims Examiner to join their team in Roseville, CA. This role involves adjudicating complex customer claims within an energetic culture, delivering innovative customer-facing solutions to clients across various industries, and being part of a rapidly growing, industry-leading global company. The position offers opportunities to leverage a global network of experts, professional development, and flexibility in daily work, location, and career path. The ideal candidate is a claims professional with California workers' compensation experience, adept at handling litigated and high-exposure claims, understanding California jurisdictional requirements, and managing claims from investigation to resolution.
Requirements
- Four (4) years of workers compensation claims management experience or equivalent combination of education and experience required.
- California jurisdictional knowledge required.
- SIP required or must be obtained within one year of hire date.
- Computer keyboarding
- Hearing, vision and talking
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Experience handling litigated and high-exposure claims.
- Understands California jurisdictional requirements.
- Can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.
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 claims within designated authority level.
- Prepares necessary state filings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Reports claims to the excess carrier and responds to requests of directions in a professional and timely manner.
Benefits
- Medical
- Dental
- Vision
- 401K on day one
- Referral incentive program
- Career development and promotional growth opportunities
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Disability and life insurance
- Paid time off (PTO)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
