Workers Compensation Claims Examiner | SIP Required

Primary Purpose To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Responsibilities Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well‑developed action plans to an appropriate and timely resolution. Negotiate settlement of claims within designated authority. Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim. Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level. Prepare necessary state filings within statutory limits. Manage the litigation process; ensure timely and cost‑effective claims resolution. Coordinate vendor referrals for additional investigation and/or litigation management. Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for clients. Manage claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Report claims to the excess carrier; respond to requests of directions in a professional and timely manner. Communicate claim activity and processing with the claimant and the client; maintain professional client relationships. Ensure claim files are properly documented and claim coding is correct. Refer cases as appropriate to supervisor and management. Additional Responsibilities Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Qualifications Bachelor's degree from an accredited college or university preferred; professional certification as applicable to line of business preferred. Four (4) years of claims management experience or equivalent combination of education and experience required. California jurisdictional knowledge required; SIP required. Benefits & Compensation Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. Diverse and comprehensive benefits offering including medical, dental, vision and 401K on day one. Additional benefits: PTO, disability and life insurance, employee assistance, flexible spending or health savings account and other voluntary benefits. Work environment considerate of reasonable accommodations as required by law. Starting pay range for this role is $80,000 – $100,000. EEO Statement Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Additional Information If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. #J-18808-Ljbffr Segment (Twilio)