Claims Examiner Workers Compensation I CA experienced required I Remote
Not Disclosed•Full-TimeRemote
location_onCarlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
About Sedgwick
By joining Sedgwick, you'll be part of something truly meaningful. As the world's leading risk and claims administration partner, we help clients thrive by navigating the unexpected. Our expertise, combined with advanced AI-enabled technology, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall.
With over 33,000 colleagues and 10,000 clients across 80 countries, we provide unmatched perspective and "caring that counts" in a rapidly changing and complex risk landscape. 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. Sedgwick has been recognized by Newsweek as one of America's Greatest Workplaces and certified as a Great Place to Work®.
About the Role
This position is designed for a Claims Examiner who will analyze complex or technically difficult workers' compensation claims to determine benefits due. You will work with high-exposure claims involving litigation and rehabilitation, ensuring ongoing adjudication within service expectations, industry best practices, and specific client service requirements. Your role is pivotal in identifying subrogation opportunities and negotiating settlements to resolve claims effectively.
In this remote role, you will manage claims through well-developed action plans to achieve timely resolutions. You will serve as a subject matter expert, utilizing your knowledge of insurance principles, laws, and cost containment strategies to guide the claims process. Your work involves maintaining professional relationships with claimants and clients while ensuring files are properly documented and compliant with statutory limits.
Hiring Process
We are always accepting applications for this role. If you're excited about this position but your experience doesn't align perfectly with every qualification, consider applying 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.
Our Culture and Commitment
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. We consider qualified applicants regardless of background. When applicable and appropriate, consideration will be given to reasonable accommodations. We are committed to fostering an environment where colleagues can handle work-related stress, manage multiple priorities, and exercise excellent judgment and discretion.
Work location
Work model: Remote
Carlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
Santa Fe, New Mexico
Key Responsibilities
- check_circleCalculate and assign timely reserves to manage claim adequacy
- check_circleCoordinate vendor referrals for investigation and litigation management
- check_circleManage claim recoveries including subrogation and Medicare offsets
- check_circleEnsure claim files are properly documented and coding is accurate
- check_circleAnalyze complex workers' compensation claims to determine benefits due and exposure
- check_circleNegotiate claim settlements within designated authority levels
- check_circleManage the litigation process to ensure cost-effective claim resolution
- check_circleCommunicate claim activity with claimants and clients to maintain relationships
- check_circlePrepare necessary state filings within statutory limits
- check_circle
Requirements
- verified5 years of claims management experience
- verifiedBachelor's degree from an accredited college or university preferred
- verifiedProfessional certification as applicable to line of business preferred
- verifiedCA experience required
- verifiedRemote work capability
Nice to Have
Bachelor's degree from an accredited college or university. Professional certification as applicable to line of business.
Benefits & Perks
check_circleMedical, dental, and vision insurancecheck_circle401k with company matchingcheck_circleDisability and life insurancecheck_circleEmployee assistance programFlexible spending account or health savings account
