Talent.com
Workers Compensation Claims Examiner | Roseville or San Diego, CA

Workers Compensation Claims Examiner | Roseville or San Diego, CA

SedgwickRoseville, CA, US
30+ days ago
Job type
  • Full-time
Job description

Workers Compensation Claims Examiner | Roseville or San Diego, CA

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work

Fortune Best Workplaces in Financial Services & Insurance

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?

  • Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
  • Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.
  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
  • Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.
  • Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
  • Enjoy flexibility and autonomy in your daily work, your location, and your career path.
  • Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Are you an ideal candidate? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Office Locations

Roseville, CA (Agile 2 Days Onsite)

San Diego, CA (Agile 2 Days Onsite)

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.

Essential Functions and Responsibilities

  • Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
  • Prepares necessary state fillings within statutory limits.
  • Manages the litigation process; ensures timely and cost effective claims resolution.
  • Coordinates vendor referrals for additional investigation and / or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manages claim recoveries, including but not limited to : subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
  • Ensures claim files are properly documented and claims coding is correct.
  • Refers cases as appropriate to supervisor and management.
  • Additional Functions and Responsibilities

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.
  • Qualification

    Education & Licensing

    Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

    Experience

    Five (5) years of claims management experience or equivalent combination of education and experience required.

    Skills & Knowledge

  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Good interpersonal skills
  • Excellent negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Service Expectations
  • 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

    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.

    Create a job alert for this search

    Claim Examiner • Roseville, CA, US

    Related jobs
    • Promoted
    Claims Examiner - Workers Comp (Hybird Roseville, CA)

    Claims Examiner - Workers Comp (Hybird Roseville, CA)

    SedgwickRoseville, CA, US
    Full-time
    Claims Examiner - Workers Comp (Hybrid Roseville, CA).Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means ...Show moreLast updated: 30+ days ago
    • Promoted
    Workers Compensation Claims Examiner | San Diego or Roseville, CA

    Workers Compensation Claims Examiner | San Diego or Roseville, CA

    SedgwickRoseville, CA, US
    Full-time
    Workers Compensation Claims Examiner.Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brand...Show moreLast updated: 30+ days ago
    • Promoted
    CA Senior WC Claims Specialist

    CA Senior WC Claims Specialist

    CorVelRepresa, CA, US
    Full-time
    CA Senior WC Claims Specialist.The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegate...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Travel CVOR Tech - $3,167 per week in Marysville, CA

    Travel CVOR Tech - $3,167 per week in Marysville, CA

    AlliedTravelCareersMarysville, CA, US
    Full-time
    AlliedTravelCareers is working with Triage Staffing LLC to find a qualified CVOR Tech in Marysville, California, 95903!.Travel Nursing : Cardiovascular OR Tech Marysville.Shift Details : 10H Days (...Show moreLast updated: 12 hours ago
    • Promoted
    Workers Compensation Claims Examiner| Dedicated Account | Rancho Cordova, CA (Agile Schedule)

    Workers Compensation Claims Examiner| Dedicated Account | Rancho Cordova, CA (Agile Schedule)

    SedgwickRancho Cordova, CA, US
    Full-time
    Workers Compensation Claims Examiner.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the un...Show moreLast updated: 30+ days ago
    • Promoted
    Senior Claims Adjuster - Workers Compensation

    Senior Claims Adjuster - Workers Compensation

    Berkshire Hathaway Homestate CompaniesSacramento, CA, US
    Full-time
    Senior Claims Adjuster - Workers Compensation.The position is located in Sacramento, California.It is a claims adjusting role in Northern California, and it is an exempt position with a hybrid work...Show moreLast updated: 30+ days ago
    • Promoted
    Workers Compensation Claims Adjuster - Remote

    Workers Compensation Claims Adjuster - Remote

    Intercare InsuranceRocklin, CA, US
    Remote
    Full-time
    Workers Compensation Claims Adjuster.MUST Reside in California & MUST have California Workers Compensation Claims Experience. Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Fresno....Show moreLast updated: 30+ days ago
    • Promoted
    Travel CT Tech - $2,688 to $3,004 per week in Folsom, CT

    Travel CT Tech - $2,688 to $3,004 per week in Folsom, CT

    AlliedTravelCareersFolsom, CT, US
    Full-time
    AlliedTravelCareers is working with Prime Time Healthcare to find a qualified CT Tech in Folsom, Connecticut!.Now Hiring : Allied Healthcare CT - Folsom, CA. Contact us for Pay Information.Actual amo...Show moreLast updated: 5 days ago
    • Promoted
    Travel Sterile Processing Tech - $1,320 per week in Auburn, CA

    Travel Sterile Processing Tech - $1,320 per week in Auburn, CA

    AlliedTravelCareersAuburn, CA, US
    Full-time +1
    AlliedTravelCareers is working with Lancesoft Inc.Sterile Processing Tech in Auburn, California, 95602!.Decontaminate surgical tools, including Davinci and scopes. Operate steam and Sterrad steriliz...Show moreLast updated: 30+ days ago
    Workers Compensation Claims Assistant

    Workers Compensation Claims Assistant

    AVONRISKRocklin, CA, US
    Full-time
    Quick Apply
    Workers Compensation Claims Assistant Job Details Job Type Full-time Rocklin, CA Description Summary : .Reports directly to the unit Claims Supervisor but takes primary direction for the assign...Show moreLast updated: 1 day ago
    • Promoted
    Workers Compensation | Claims Examiner | Hybrid

    Workers Compensation | Claims Examiner | Hybrid

    SedgwickRoseville, CA, US
    Full-time
    Workers Compensation Claims Examiner.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the un...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Sterile Processing Tech - $1,340 per week in Auburn, CA

    Travel Sterile Processing Tech - $1,340 per week in Auburn, CA

    AlliedTravelCareersAuburn, CA, US
    Full-time +1
    AlliedTravelCareers is working with Lancesoft Inc.Sterile Processing Tech in Auburn, California, 95602!.Shift : Day 5x8-Hour (07 : 00 - 15 : 30). Accepted certifications include CRCST or CSPDT.Weekend ca...Show moreLast updated: 5 days ago
    • Promoted
    Travel Certified Occupational Therapist Assistant (COTA) - $1,349 to $2,032 per week in Auburn, CA

    Travel Certified Occupational Therapist Assistant (COTA) - $1,349 to $2,032 per week in Auburn, CA

    AlliedTravelCareersAuburn, CA, US
    Full-time
    AlliedTravelCareers is working with CompHealth to find a qualified Certified Occupational Therapist Assistant (COTA) in Auburn, California, 95602!. Though your CompHealth recruiter will be your sing...Show moreLast updated: 13 days ago
    • Promoted
    Travel Occupational Therapist (OT) - $1,939 per week in Auburn, CA

    Travel Occupational Therapist (OT) - $1,939 per week in Auburn, CA

    AlliedTravelCareersAuburn, CA, US
    Full-time
    AlliedTravelCareers is working with Prime HealthCare Staffing to find a qualified Occupational Therapist (OT) in Auburn, California, 95602!. Prime HealthCare Staffing, a national health care staffin...Show moreLast updated: 14 days ago
    • Promoted
    Workers Compensation Lien Claims Professional

    Workers Compensation Lien Claims Professional

    Berkshire Hathaway Homestate CompaniesSacramento, CA, US
    Full-time
    Workers Compensation Lien Claims Professional.Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Lien Claims Professional to join our Sacramento team! This adju...Show moreLast updated: 30+ days ago
    • Promoted
    Senior Claims Adjuster - Workers Compensation (Sacramento)

    Senior Claims Adjuster - Workers Compensation (Sacramento)

    Berkshire Hathaway Homestate CompaniesSacramento, CA, United States
    Full-time
    Senior Claims Adjuster - Workers Compensation.The position is located in Sacramento, California.It is a claims adjusting role in Northern California, and it is an exempt position with a hybrid work...Show moreLast updated: 7 days ago
    • Promoted
    Claims Examiner - Workers Compensation

    Claims Examiner - Workers Compensation

    SedgwickRancho Cordova, CA, US
    Full-time
    Claims Examiner - Workers Compensation.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the ...Show moreLast updated: 30+ days ago
    • Promoted
    Workers Comp Claims Oversight Specialist

    Workers Comp Claims Oversight Specialist

    Samuel HaleRancho Cordova, CA, US
    Full-time
    Join Our Dynamic Team as a Workers' Comp Claims Oversight Specialist!.In-Office, Rancho Cordova, CA 95670.Engineered Employment Products. Our diverse team is powered by forward-thinkers, innovators,...Show moreLast updated: 23 days ago