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Sedgwick दुनिया भर के संगठनों को प्रौद्योगिकी-सक्षम जोखिम, लाभ और एकीकृत कारोबारी समाधान प्रदान करता है। इसके कार्यों में दुर्घटना, स्वास्थ्य, विकलांगता, बेरोज़गारी मुआवज़े और देयता दावों का प्रबंधन शामिल है। साथ ही, कंपनी परामर्श, फॉरेंसिक लेखांकन, फॉरेंसिक इंजीनियरिंग, संपत्ति बहाली, ब्रांड संरक्षण और हानि-निवारण सेवाएँ विकसित करती है। Sedgwick निर्माण, परामर्श, स्वास्थ्य सेवा, कृषि और पर्यावरणीय सेवाओं सहित विभिन्न उद्योगों में ग्राहकों का समर्थन करता है तथा विविधता, समानता, समावेशन और पर्यावरणीय, सामाजिक एवं शासन संबंधी प्रथाओं पर ध्यान केंद्रित करने की बात करता है।
Sedgwick Workers' Compensation Claims Examiner, California Remote
Sedgwick seeks a California-based workers' compensation claims examiner to manage complex claims from investigation through resolution. The role covers litigation, settlements, reserves, payments, recoveries, and client communication.
संयुक्त राज्य
कैलिफ़ोर्निया$80,000 – $1,00,000 / वर्ष
रिमोटपूर्णकालिकमध्य स्तरवरिष्ठआवश्यक भाषा: अंग्रेज़ीदावा विशेषज्ञविवरण
- Evaluate complex workers' compensation claims and determine payable benefits
- Investigate claims and collect information to assess exposure
- Drive claims to timely, appropriate resolution through documented action plans
- Negotiate settlements within delegated authority
- Set and monitor reserves throughout the claim lifecycle
- Calculate and issue benefits, approve payment adjustments, and settle claims within authority
- Complete required state filings within statutory deadlines
- Oversee litigation for timely and cost-effective outcomes
- Coordinate vendors supporting investigations and litigation
- Use cost-containment methods and strategic vendor relationships
- Manage recoveries involving subrogation, Second Injury Fund excess claims, and Social Security and Medicare offsets
- Report claims to excess carriers and address requests for direction
- Explain claim activity and processing to claimants and clients
- Build and maintain professional client relationships
- Keep claim files complete and ensure accurate claims coding
- Escalate appropriate cases to supervisors and management
आवश्यकताएँ
- At least five years of claims management experience, or an equivalent combination of education and experience
- Knowledge of California claims jurisdiction and regulations
- SIP certification, or the ability to obtain it within one year of employment
- Bachelor's degree from an accredited college or university preferred
- Relevant professional certification preferred where applicable to the business line
- Capability to evaluate and process complex or technically challenging workers' compensation claims
- Working knowledge of claims investigation, reserves, benefit payments, settlements, litigation, subrogation, recoveries, and cost containment
- Ability to complete required state filings within statutory deadlines
- Ability to oversee claims and litigation processes
- Professional communication skills for working with claimants and clients
- Ability to maintain complete claim documentation and accurate coding
लाभ
- Flexible scheduling
- Employee referral incentive program
- Career development and advancement opportunities
- Medical, dental, and vision coverage
- 401(k) plan with matching
- Paid time off
- Disability and life insurance coverage
- Employee assistance program
- Flexible spending account or health savings account
- Additional voluntary benefits
- Support for work-life balance
- Professional development opportunities
- Flexibility and autonomy over daily work, location, and career direction
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