Workers Compensation Claims Examiner

4 days ago


Beverly Hills, California, United States Sedgwick Full time
Job Summary

We are seeking a skilled Workers Compensation Claims Examiner to join our team at Sedgwick. As a Claims Examiner, you will be responsible for analyzing and processing California Workers Compensation claims to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Key Responsibilities
  • Analyze and process claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
  • Report claims to the excess carrier and respond to requests for directions in a professional and timely manner.
  • Manage claim recoveries if applicable.
  • Negotiate settlement of claims within designated authority.
  • Refer cases as appropriate to supervisor and management.
  • Calculate and assign timely and appropriate reserves to claims.
  • Ensure claim files are properly documented and claims coding is correct.
  • Communicate claim activity and processing with the claimant and the client.
Requirements
  • High School Diploma or GED required.
  • Bachelor's degree from an accredited college or university preferred.
  • Claims Adjusters & Examiners: 4+ years Claims Team Leads: 6+ years claims industry experience and 2+ years of supervisory experience.
  • Licensed to handle claims in the state of CA required.
  • SIP Certification highly preferred.
What We Offer
  • 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 1.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.



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