Workers Compensation Claims Examiner | Rancho Cordova, CA | Hybrid

Overview

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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Workers Compensation Claims Examiner | Rancho Cordova, CA | Hybrid

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?

• 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.

• Analyze complex or technically difficult workers  compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; and 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.

• Negotiate settlement of claims within designated authority.

• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.

• Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.

• Prepare necessary state filings within statutory limits.

• Manage the litigation process; ensure timely and cost effective claims resolution.

• Coordinate vendor referrals for additional investigation and/or litigation management.

• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

• Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

• Report claims to the excess carrier; respond to requests of directions in a professional and timely manner.

• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.

• Ensure claim files are properly documented and claims coding is correct.

• Refer cases as appropriate to supervisor and management.

Education & Licensing

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

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.

• Flexible work schedule.

• Referral incentive program.

• Career development and promotional growth opportunities.

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

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting…