Claims Examiner I, Workers Compensation

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluate workers' compensation claims on behalf of clients to ascertain due benefits

• Maintain the ongoing adjudication of claims in accordance with service expectations, industry best practices, and client requirements

• Analyze and manage claims through action plans to achieve timely resolutions

• Investigate claims and collect information to assess claim exposure

• Negotiate settlements of claims within the defined authority

• Communicate claim activities and processing updates to claimants and clients

• Report claims to the excess carrier

• Respond promptly and professionally to requests for directions

• Utilize Sedgwick's global network of experts to gain and share insights

• Provide customer-facing solutions to clients across various industries

⛳️ Requirements

• Minimum of 5 years of experience in claims management or an equivalent combination of education and experience

• High School Diploma or GED is required

• A bachelor's degree from an accredited college or university is preferred

• Professional certification relevant to the line of business is preferred

• Knowledge and experience in workers' compensation claims examination

• Familiarity with California jurisdiction knowledge and licensing

• Capacity to analyze and process claims effectively

• Ability to investigate claims and gather pertinent information to assess exposure

• Proficiency in negotiating claim settlements within the established authority

• Capability to communicate claim activities and processing details to claimants and clients

• Skill in reporting claims to the excess carrier and responding to requests for directions

• Proficient computer keyboarding skills

• Adequate hearing, vision, and speaking abilities

• Strong clear and conceptual thinking abilities

• Excellent judgment and discretion

• Ability to meet deadlines effectively

🏝️ Benefits

• Flexible work schedule

• Referral incentive program

• Opportunity to work in an agile environment

• Career development and promotional growth opportunities

• Medical, dental, and vision insurance

• 401(k) plan with matching contributions

• Paid time off (PTO)

• Disability and life insurance

• Employee assistance programs

• Flexible spending or health savings accounts

• Additional voluntary benefits available

• Flexible and autonomous options for daily work, location, and career paths

• Opportunities for professional development