Workers Compensation Claims Examiner - CA or NV license required (Remote)

Job summary

Analyze and process workers compensation claims to determine benefits due while ensuring adherence to service expectations and industry best practices. Negotiate claim settlements within designated authority and maintain professional communication with claimants and clients.

Job details

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 Workers Compensation Claims Examiner - CA or NV license required (Remote) 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 examiner 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. WORK LOCATION This position is currently designated as remote. However, candidates must reside within a reasonable commuting distance of, or be willing to relocate to, the Salt Lake City, Utah area. The successful candidate will be expected to transition to a hybrid work schedule and report to the Salt Lake City office. 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 RESPONSIBLITIES MAY INCLUDE * Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. * Negotiating settlement of claims within designated authority. * Communicating claim activity and processing with the claimant and the client. * Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. QUALIFICATIONS Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience: 5 years of claims management experience or equivalent combination of education and experience required. Licensing / Jurisdiction Knowledge: Must be licensed in California or Nevada 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 REQUIREMENTS INCLUDE 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 range of starting pay for this role is (80k-100k). 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. #claimsexaminer #claims #LI-REMOTE 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. 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.

What you’ll do

Analyze and process workers compensation claims to determine benefits due while ensuring adherence to service expectations and industry best practices. Negotiate claim settlements within designated authority and maintain professional communication with claimants and clients.

Requirements

Requires a high school diploma or GED, with a bachelor's degree preferred, and at least 5 years of claims management experience. Must hold a valid workers compensation claims examiner license in California or Nevada.

Benefits

• Medical • Dental • Vision • 401k • 401k matching • Paid time off • Disability insurance • Life insurance • Employee assistance program • Flexible spending account • Health savings account • Referral incentive program • Career development opportunities

Listed skills

• Time management · Preferred
• Customer service · Preferred
• Problem solving · Preferred
• Regulatory Compliance · Preferred
• Negotiation · Preferred
• Communication · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Workers compensation
• Claims adjudication
• Claims management
• Negotiation
• Investigation
• Risk assessment
• Customer service
• Problem solving
• Analytical skills
• Time management
• Communication
• Regulatory compliance
• Empathy
• Workers' Compensation Claims
• Workplace Inclusivity
• Energetic
• Accountability
• Ability To Meet Deadlines
• Information Gathering
• Adjudication
• Management
• Claims Processing
• Customer Service
• Financial Services
• Settlement
• Innovation

Job areas

• Finance & Accounting
• Customer Service & Support
• Legal
• Management & Leadership
• Workers' Compensation Claims Examiner
• Claims Examiner (General)
• Valuers and Loss Assessors
• Claims Adjusters, Examiners, and Investigators