Claims Adjuster - Workers | Ontario, CA

Claims Adjuster - Workers | Ontario, CA ARE YOU AN IDEAL CANDIDATE? Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‑managed intake environment.

OFFICE LOCATIONS

Ontario, CA (Hybrid) PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. Develops and manages workers compensation claims’ action plans to resolution, coordinates return-to-work efforts, and approves claim payments. Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client. Ensures claim files are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. Maintains professional client relationships.

QUALIFICATIONS

Education & Licensing Bachelor’s degree from an accredited college or university preferred. Experience Four (4) years of claims management experience or equivalent combination of education and experience required. Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.

TAKING CARE OF YOU

Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT

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, travel as required 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 range of starting pay for this role is $60,000 - $80,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. 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. Sedgwickis an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr Dormont Manufacturing Company