Claims Examiner - Workers Compensation (HYBRID- West Hills, CA/3 Days Remote)

Claims Examiner – Workers Compensation (HYBRID – West Hills, CA / 3 Days Remote)

PRIMARY PURPOSE OF THE ROLE

To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBILITIES

Analyze and process claims through well‑developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. Negotiate settlement of claims within designated authority. Communicate claim activity and processing with the claimant and the client. Report claims to the excess carrier and respond to requests or directions in a professional and timely manner.

QUALIFICATIONS

Education and experience: 5 years of claims management experience or equivalent combination of education and experience required. High School Diploma or GED required; Bachelor’s degree from an accredited college or university preferred. Professional certification as applicable to the line of business preferred. Licensing / Jurisdiction Knowledge SIP required or must be obtained within one (1) year of employment; California workers compensation jurisdictional knowledge required.

TAKING CARE OF YOU

Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. Diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits.

WORK ENVIRONMENT REQUIREMENTS

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem‑solving, analysis, and discretion; ability to handle work‑related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical: Computer keyboarding. Auditory/Visual: Hearing, vision, and talking. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the starting pay range for this role is $80,000 – $90,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

EEO & DISABILITY AFFAIRS

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. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement