Claims Examiner Workers Compensation Long Beach CA Hybrid
Claims Examiner Workers Compensation Long Beach CA Hybrid
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$ 70000 - 105000
1 Vacancy
Job Description
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 experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Its an opportunity to do something meaningful each and every day. Its having support for your mental physical financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference who enjoys a challenge and above all if youre someone who cares theres a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes BestinState Employer
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 worlds best brands
- Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
- Deliver innovative customerfacing solutions to clients who represent virtually every industry and comprise some of the worlds most respected organizations.
- Be a part of a rapidly growing industryleading global company known for its excellence and customer service.
- Leverage Sedgwicks 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
Long Beach CA (Hybrid 2 days inoffice)
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
- Analyzes and processes complex or technically difficult workers compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through welldeveloped 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 organizations quality program(s).
- Travels as required.
QUALIFICATION
Education & Licensing
Bachelorsdegree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Five 5 years of California workers compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: SIP required or must be obtained within one 1 year of start date.
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.
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 $70000 $105000. 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.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.They are not intended to constitute a comprehensive list of functions duties or local variances.Management retains the discretion to add or to change the duties of the position at any time.
#Claims #Claimsexaminer
Sedgwickis an Equal Opportunity Employer and a DrugFree Workplace.
If youre excited about this role but your experience doesnt 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.
Employment Type
Full-Time
