Workers Compensation Claims Examiner

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

📋 Description

• Assess Workers Compensation claims on behalf of clients to determine the benefits owed.

• Ensure the continuous adjudication of claims aligns with service expectations, industry standards, and client service requirements.

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

• Investigate and collect information to evaluate claim exposure.

• Negotiate claim settlements within the established authority.

• Communicate claim activities and processing updates with claimants and clients.

• Report claims to the excess carrier.

• Respond to requests for direction in a professional and timely manner.

• Utilize Sedgwick’s global network of experts to deliver effective customer-facing solutions.

⛳️ Requirements

• A minimum of 4 years of claims management experience or an equivalent combination of education and experience is required.

• A High School Diploma or GED is required.

• Knowledge of California workers' compensation jurisdiction is essential.

• SIP certification is required or must be obtained within one (1) year of employment.

• A Bachelor’s degree from an accredited college or university is preferred.

• Professional certification relevant to the line of business is preferred.

• Strong ability for clear and conceptual thinking.

• Excellent judgment, troubleshooting, problem-solving, analytical skills, and discretion are necessary.

• Capability to manage work-related stress effectively.

• Ability to juggle multiple priorities at the same time.

• Must be able to meet deadlines.

• Proficient in computer keyboarding.

• Required skills include hearing, vision, and speaking.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotional growth.

• A diverse and comprehensive benefits package, including medical, dental, vision, and 401K from day one.

• 401K with matching contributions.

• Paid Time Off (PTO).

• Disability and life insurance.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits available.

• Emphasis on work-life balance.

• Flexibility and autonomy in daily work, location, and career path.

• Opportunities for professional development.