Claims Adjuster, Workers' Compensation

1 week ago


Long Beach, California, United States Sedgwick Full time

At Sedgwick, we believe in the value of caring for our colleagues and clients alike. Our mission is to provide exceptional service and support to those who need it most.

What We Offer:

We offer a comprehensive benefits package that includes medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

About This Role:

This is a challenging and rewarding opportunity to work as a Claims Adjuster, Workers' Compensation at Sedgwick. In this role, you will be responsible for analyzing complex claims and determining benefits due, negotiating settlements, and managing reserve adequacy throughout the life of the claim.

Key Responsibilities:

  • Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure on the claim.
  • 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.
  • Prepare necessary state fillings within statutory limits.
  • Manage the litigation process, ensuring timely and cost-effective claims resolution.
  • Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for clients.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Communicate claim activity and processing with claimants and clients, maintaining professional relationships.
  • Ensure claim files are properly documented and coding is correct.

Requirements:

  • Bachelor's degree from an accredited college or university preferred.
  • Five years of claims management experience or equivalent combination of education and experience required.
  • Subject matter expert of insurance principles and laws, recoveries offsets and deductions, claim and disability duration, cost containment principles, and medical management practices.
  • Excellent oral and written communication, including presentation skills.
  • PC literate, including Microsoft Office products.
  • Analytical and interpretive skills.
  • Strong organizational skills.
  • Good interpersonal skills.
  • Excellent negotiation skills.

Salary Range: $75,000 - $100,000 per year

About Sedgwick: Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our team of over 30,000 colleagues across 80 countries is dedicated to making a positive impact on the world through the people and organizations we serve.



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