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Sedgwick
Sedgwick
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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.
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Workers' Compensation Claims Examiner - California Remote

Sedgwick is seeking a remote California Workers' Compensation Claims Examiner to manage complex, litigated, and high-exposure claims. The role covers investigation, benefit determination, reserves, settlement, litigation, and customer collaboration.

USUnited StatesCACalifornia
$85,000 – $110,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredClaims Specialist

Description

  • Evaluate complex or technically challenging California workers' compensation claims and determine the benefits owed
  • Investigate claims and collect information to assess exposure
  • Use action plans to move claims toward timely and appropriate resolution
  • Negotiate settlements within assigned authority
  • Calculate and establish timely, appropriate claim reserves
  • Monitor reserve adequacy throughout each claim's lifecycle
  • Calculate and issue benefits, approving and processing timely payments and adjustments
  • Resolve claims within the assigned authority level
  • Complete required state filings within statutory deadlines
  • Oversee litigation and support timely, cost-effective claim resolution
  • Report claims to excess carriers and respond to direction requests
  • Identify subrogation opportunities and negotiate related settlements
  • Provide customer-focused solutions while working with clients and global subject-matter experts

Requirements

  • Experience handling California workers' compensation claims
  • At least four years of California workers' compensation claims management experience, or an equivalent combination of education and experience
  • Experience managing litigated and high-exposure claims
  • Working knowledge of California jurisdictional requirements
  • Background managing claims from investigation and benefit determination through settlement negotiation and resolution
  • Bachelor's degree from an accredited college or university preferred
  • Relevant professional certification preferred, where applicable to the line of business
  • Knowledge of California jurisdictional requirements
  • SIP certification required or obtainable within one year of hire
  • Capacity to assess complex or technically difficult workers' compensation claims
  • Ability to investigate claims and compile exposure information
  • Ability to calculate and assign reserves and benefits
  • Ability to oversee litigation processes
  • Ability to complete required state filings within statutory deadlines
  • Strong conceptual and analytical thinking skills
  • Sound judgment, troubleshooting, problem-solving, analytical, and discretionary skills
  • Ability to manage work-related stress and multiple priorities concurrently
  • Ability to meet deadlines consistently
  • Computer keyboarding, hearing, vision, and verbal communication abilities

Benefits

  • Flexible scheduling
  • Employee referral incentive program
  • Career development and advancement opportunities
  • Medical, dental, and vision insurance
  • 401(k) plan with matching contributions
  • Paid time off
  • Disability and life insurance
  • Employee assistance program
  • Flexible spending account or health savings account
  • Additional voluntary benefits
  • Flexible work location with autonomy over daily work

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