Workers Compensation Claims Examiner

3 weeks ago

Toronto, Ontario, Canada Sedgwick Full time
About Sedgwick

Sedgwick is a global industry leader in claims management and workers' compensation services. We're committed to delivering exceptional customer experiences and making a positive impact on the world through the people and organizations we serve.

Job Summary

We're seeking a skilled Workers Compensation Claims Handler to join our team in California. As a Claims Handler, you'll play a critical role in analyzing and processing claims to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Key Responsibilities
  • Analyze and process claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
  • Report claims to the excess carrier and respond to requests for directions in a professional and timely manner.
  • Manage claim recoveries if applicable.
  • Negotiate settlement of claims within designated authority.
  • Refer cases as appropriate to supervisor and management.
  • Calculate and assign timely and appropriate reserves to claims.
  • Ensure claim files are properly documented and claims coding is correct.
  • Communicate claim activity and processing with the claimant and the client.
Requirements
  • High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
  • 4+ years of claims industry experience for Claims Adjusters & Examiners, and 6+ years of claims industry experience with 2+ years of supervisory experience for Claims Team Leads.
  • California jurisdiction experience. Licensed to handle claims in the state of CA required.
What We Offer
  • 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 1.

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.

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