Workers Compensation Claims Examiner

Sedgwick • Brea, CA

22h • $73,000 - $85,000

About The Position

The Workers Compensation Claims Examiner 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 claims through resolution, including determining compensability, monitoring reserve accuracy, preparing required state documentation, coordinating return-to-work efforts, approving payments, and communicating claim actions to claimants and clients. 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 examiner maintains professional client relationships and supports the organization’s quality programs. The office location is Brea, California; travel is required as needed.

Requirements

• Three years of California workers compensation claims management experience, or an equivalent combination of education and experience.
• California jurisdictional knowledge.
• SIP required, or must be obtained within one year of employment.

Nice To Haves

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

Responsibilities

• Manage workers compensation claims, determine compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agencies.
• Develop and manage claims 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 according to the claim or client contract.
• Manage claim subrogation and negotiate settlements.
• Communicate claim actions with claimants and clients.
• Ensure claim files are properly documented and claim coding is correct.
• When applicable, process complex lifetime medical and/or defined-period medical claims, including state and physician filings and decisions on treatments recommended by utilization review.
• Maintain professional client relationships.
• Perform other duties as assigned.
• Support the organization's quality programs.
• Travel as required.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Medical, dental, and vision coverage.
• 401(k) 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: Mid Level