Remote Workers Compensation Claims Examiner | CA Jurisdiction

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Full time

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.

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Remote Workers Compensation Claims Examiner | CA Jurisdiction

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• California workers' compensation claims experience required.

• SIP certification preferred/required depending on client assignment and state of residence.

ARE YOU AN IDEAL CANDIDATE? We're looking claim's professionals with California workers' compensation experience who enjoy solving complex problems and delivering outstanding service. The ideal candidate has experience handling litigated and high-exposure claims, understands California jurisdictional requirements, and can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.

PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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.

• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

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

Experience:

Three (3) years of California workers compensation claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge:
California jurisdictional knowledge required; SIP required or…