LogoFresh Jobs Ahead
Sedgwick
Sedgwick
H1B Visa SponsorConstructionConsultingHealthcare
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.
LinkedIn
Company Jobs

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.

USUnited StatesCACalifornia
$80,000 – $100,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredClaims Specialist

Description

  • 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

Requirements

  • 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

Benefits

  • 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

Related Jobs

ZACO Robot

B2B Sales Setter for Commercial Cleaning Robotics

ZACO Robot
11 – 50 Employees
ConstructionConsultingLogistics
€3,000 – €6,000 / month
RemoteFull-timeMiddleSeniorGerman RequiredSales

Qualify leads and book sales calls for RV-Tech’s professional cleaning robots, selling remotely to business decision-makers. The role focuses on automation and robotics in a growing commercial market.

Open