Claims Examiner | Workers Compensation | Must have 4850 Experience | Hybrid - Rancho Cucamonga, CA
Telecommuter CA, United States
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. It’s an opportunity to do something meaningful, each and every day. It’s 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 you’re someone who cares, there’s 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 Best-in-State 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 world’s best brands?
- Apply your 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.
OFFICE LOCATIONS
Rancho Cucamonga, CA (2 days a week in-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: 5 years of claims management experience or equivalent combination of education and experience required.
- 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.
Licensing / Jurisdiction Knowledge: SIP
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 ($71,000-$95,000)(bonus eligibility, if applicable). 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 #hybrid #LI-HYBRID #LI-DV1
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.
ApplyJob Profile
2 days in office Hybrid Hybrid work model Telecommuter
Benefits/Perks401k and matching 401k from day one Autonomy Career development Career development opportunities Comprehensive benefits Comprehensive benefits package Comprehensive health benefits Dental Disability Employee assistance Flexibility Flexibility and autonomy Flexible Spending Flexible work Flexible Work Schedule Health savings account Hybrid work Life Insurance Medical Professional development Professional development opportunities Promotional growth PTO Referral incentive program Vision Voluntary benefits
Tasks- Adjudicate claims
- Analyze workers compensation claims
- Assess claim exposure
- Communicate with claimants and clients
- Determine benefits
- Determine benefits due
- Develop action plans
- Ensure compliance with industry standards
- Gather information
- Investigate claims
- Negotiate settlements
- Report claims
- Resolve claims
Action plans Adjudication Autonomy in Work Benefit Determination Claims Action Planning Claims Adjudication Claims analysis Claims Communication Claims compliance Claims Compliance Certifications Claims Compliance Standards Claims Customer Engagement Claims Customer Satisfaction Claims Customer Satisfaction Certifications Claims Customer Service Claims Customer Service Certifications Claims Customer Support Claims Customer Support Certifications Claims Data Analysis Claims Data Analysis Certifications Claims Data Analysis Tools Claims Data Gathering Claims data management Claims Data Management Certifications Claims Documentation Claims Documentation Certifications Claims Documentation Standards Claims Exposure Assessment Claims follow-up Claims Follow-up Certifications Claims Follow-up Procedures Claims Industry Best Practices Claims Industry Certifications Claims Industry Knowledge Claims Industry Knowledge Certifications Claims Industry Regulations Claims Industry Regulations Certifications Claims Industry Standards Claims Industry Standards Certifications Claims investigation Claims Investigation Certifications Claims Investigation Techniques Claims management Claims Management Certifications Claims Management Tools Claims negotiation Claims Negotiation Certifications Claims Process Improvement Claims Process Improvement Certifications Claims processing Claims Processing Certifications Claims processing software Claims Process Optimization Claims Process Optimization Certifications Claims Quality Assurance Claims Quality Assurance Certifications Claims Quality Control Claims Quality Control Certifications Claims Regulations Claims reporting Claims Reporting Certifications Claims Reporting Tools Claims resolution Claims Resolution Certifications Claims Resolution Strategies Claims settlement Claims Workflow Claims Workflow Certifications Claims Workflow Management Client Communication Client Relations Client service Collaboration Customer-Facing Solutions Customer service Disability Empathy Flexibility Growth Inclusion Industry Best Practices Information Gathering Insurance Insurance Claims IT Jurisdiction knowledge Management Negotiating Problem-solving Professional Development Reporting Service Expectations Settlement Settlement negotiation Workers Compensation
Experience5 years
EducationBachelor's degree Equivalent GED Health High school diploma
Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9