Sedgwick
Sedgwick
Sedgwick бүкіл әлемдегі ұйымдарға технологияға негізделген тәуекелдерді басқару, қызметкерлерге берілетін жеңілдіктер және интеграцияланған бизнес шешімдерін ұсынады. Компания жазатайым оқиға, денсаулық, еңбекке жарамсыздық, жұмыссыздық бойынша өтемақы және жауапкершілік талаптарын реттеумен қатар, консалтинг, сот-бухгалтерлік сараптама, сот-инженерлік сараптама, мүлікті қалпына келтіру, брендті қорғау және шығындардың алдын алу қызметтерін дамытады. Sedgwick құрылыс, консалтинг, денсаулық сақтау, ауыл шаруашылығы және қоршаған ортаны қорғау қызметтері сияқты салалардағы клиенттерге қолдау көрсетеді және әртүрлілікке, теңдікке, инклюзияға, сондай-ақ экологиялық, әлеуметтік және корпоративтік басқару тәжірибелеріне басымдық беретінін мәлімдейді.

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.

Сипаттама

  • 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

Талаптар

  • 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

Артықшылықтар

  • 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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