Workers Compensation - Claims Standards & Compliance Analyst | Ontario, California

Sedgwick•Ontario, CA

11d•$80,000 - $98,000•Hybrid

About The Position

This role supports the timely and accurate delivery of benefits and required notices to minimize regulatory penalties, legal exposure, and other adverse outcomes. The primary purpose of this role is to ensure product quality and regulatory compliance while serving as a trusted resource to office operations. The company is a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands. Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Requirements

5 years of claims management experience or equivalent combination of education and experience required.
High School Diploma or GED required.
California workers' compensation claims knowledge
SIP Certificate Required

Nice To Haves

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

Responsibilities

Develops, reviews, and analyzes management reports related to claim processes and decisions to ensure legal and regulatory compliance.
Designs and supports training programs and technical materials to monitor, prevent, and mitigate legal and regulatory claim‑handling exposures, in collaboration with Sedgwick University as needed.
Participates in roundtable reviews of claim strategy and provides recommendations aligned with legally compliant file‑handling standards.
Supports and participates in projects related to process, procedural, and compliance updates, including communication of changes to field offices, IT, Legal, and other business units.
Prepares offices for regulatory audits, serves as a liaison with state auditors, participates in audit debriefs, and assists in developing rebuttal responses when required.
Educates colleagues, managers, and clients on state regulatory requirements and supports resolution of regulatory and compliance issues.
Partners with internal quality programs and practice leads to share insights, promote consistent adoption of required forms and procedures, and develop mitigation strategies across business units.
A reduced caseload can be expected with seemingly complex matters or high visibility claims.
Program compliance initiatives supported for audit compliance, subject to but not limited to benefit timeliness and accuracy, file balancing compliance, training for penalty and interest avoidance strategies, and mitigation of excess costs.