Sedgwick provides technology-enabled risk, benefits, and integrated business solutions for organizations worldwide. Its work includes administering accident, health, disability, unemployment compensation, and liability claims, alongside building consulting, forensic accounting, forensic engineering, property restoration, brand protection, and loss prevention services. Sedgwick supports clients across industries including construction, consulting, healthcare, agriculture, and environmental services, with a stated focus on diversity, equity, inclusion, and environmental, social, and governance practices.
California Workers' Compensation Claims Examiner – Hybrid
Sedgwick seeks a claims examiner to manage complex California workers' compensation claims. The role covers investigations, benefit determinations, litigation, reserves, settlements, payments, and claim resolution.
United States
California$80,000 – $100,000 / year
HybridFull-timeMiddleSeniorEnglish RequiredClaims SpecialistDescription
- Analyze and administer complex or technically challenging California workers' compensation claims
- Investigate claims and collect information to assess exposure
- Use action plans to guide claims toward timely, appropriate resolution
- Negotiate settlements within assigned authority
- Set and review reserves promptly to maintain adequacy
- Calculate benefits, approve and issue payments, and process adjustments on time
- Resolve claims within the assigned authority level
- Complete required state filings within statutory deadlines
- Oversee litigation for timely and cost-effective claim outcomes
- Report claims to excess carriers and respond to direction requests
- Identify subrogation opportunities and negotiate related settlements
- Adjudicate claims in line with service standards, industry practices, and client requirements
Requirements
- At least four years of California workers' compensation claims management experience, or an equivalent combination of education and experience
- Practical experience with California workers' compensation claims
- Background handling litigated and high-exposure claims
- Working knowledge of California jurisdictional requirements
- SIP certification required or obtainable within one year of hire
- Bachelor's degree from an accredited college or university preferred
- Relevant professional certification preferred where applicable to the business line
- Ability to investigate claims and assess exposure from gathered information
- Ability to manage litigation and negotiate settlements
- Ability to calculate reserves and benefits and process payments and adjustments
- Ability to complete required state filings within statutory deadlines
- Clear, conceptual thinking skills
- Strong judgment, troubleshooting, problem-solving, analytical, and discretionary abilities
- Ability to manage work-related stress and multiple priorities
- Ability to meet deadlines consistently
- Computer keyboarding proficiency
- Ability to hear, see, and communicate verbally
Benefits
- Flexible scheduling
- Employee referral incentive program
- Career development and advancement opportunities
- Medical, dental, and vision coverage
- 401(k) plan with employer matching
- Paid time off
- Disability and life insurance
- Employee assistance program
- Flexible spending account or health savings account
- Additional voluntary benefits
- Hybrid work arrangement
- Reasonable accommodations when applicable and appropriate