Workers Compensation Claims Adjuster | Brea, CA
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Job Summary
By joining Sedgwick youll be part of something truly meaningful. Its what our 33000 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 theres no limit to what you can achieve.
Newsweek Recognizes Sedgwick as Americas Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Workers Compensation - Claims Adjuster Brea CAOFFICE LOCATION:
Brea CA (3 days In Office/2 days WFH)
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.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organizations quality program(s).
Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelors degree from an accredited college or university preferred.
Experience
Three (3) years of claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California workers compensation claims experience required SIP Preferred
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 $65000 - $85000/yr. 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.
#claimsadjuster #claims #hybrid
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.
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.
Required Experience:
IC
About Company
Sedgwick's tech-enabled risk, benefits, and integrated business solutions include comprehensive claims management and loss adjusting across industries.
