- 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.
- 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 well-developed 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- 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.
-
Claims Examiner
4 weeks ago
NESCO Inc Concord, United StatesPRIMARY PURPOSE: To analyze complex or technically difficult general liability 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 practice ...
-
TPA Claims Examiner
3 days ago
Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States· Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellen ...
-
TPA Claims Examiner
3 weeks ago
Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States· Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellen ...
-
Tpa Claims Examiner
1 week ago
Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United StatesAre you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellent c ...
-
Tpa Claims Examiner
2 days ago
Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United StatesAre you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellent c ...
-
Claims Examiner III
3 weeks ago
Tristar Insurance Services LLC Concord, United StatesJob Details · Level · Experienced · Job Location · Concord Office - Concord, CA · Remote Type · Hybrid · Position Type · Full Time · Education Level · High School Diploma or GED · Salary Range · $90, $95,000.00 Salary/year · Travel Percentage · None · Job Shift · D ...
-
Workers Compensation Claims Examiner
1 week ago
Sedgwick Claims Management Services Concord, United StatesTo analyze California 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. Workers Compensation, Claims, ...
-
Workers Compensation Claim Examiner
1 week ago
Sedgwick Claims Management Services, Inc. Concord, United StatesTaking 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 opportuni ...
-
Workers' Compensation Claims Examiner
1 week ago
Sedgwick Claims Management Services, Inc. Concord, United StatesTaking 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 opportuni ...
-
Workers Compensation Claims Examiner
1 week ago
Sedgwick Concord, United StatesTaking 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 opportuni ...
-
Workers Compensation Claims Examiner
3 days ago
Sedgwick Concord, United StatesTaking 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 opportuni ...
-
Workers Compensation Claim Examiner
3 weeks ago
Sedgwick Concord, United StatesTaking 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 opportuni ...
-
Senior Claims Examiner
3 weeks ago
Berkley Walnut Creek, United StatesCompany Details: · Berkley Enterprise Risk Solutions will offer specialized workers compensation solutions to California-based clients with sophisticated risk management capabilities and interests. We are pleased to be expanding our expertise to this segment of the market with d ...
-
Claims Examiner
2 weeks ago
JT2 Integrated Resources Oakland, United StatesJT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration wi ...
-
Claims Examiner
3 weeks ago
JT2 Integrated Resources Oakland, United StatesJT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration wi ...
-
Claims Examiner
2 weeks ago
AppleOne Fremont, United StatesJob Description · Job DescriptionJob Headline: Claims Examiner · Job Title: Claims Examiner · Location: Fremont, CA. 94538 · Great Pay up to $57K · Immediate need for Claims Examiner seeking to work for a collaborative team in the insurance/healthcare business. Company offers exc ...
-
Claims Examiner
2 weeks ago
San Francisco Health Plan San Francisco, United StatesJob Description · Job DescriptionYou can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Claims Examiner. · The Claims Examiner is responsible for claims processing, adjudication, and research. In addition, this position keeps c ...
-
Claims Examiner II
3 weeks ago
Partnership HealthPlan of California Fairfield, United StatesOverview: · To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions ta ...
-
Senior Claims Examiner
1 week ago
AssuredPartners Oakland, United StatesOverview: · Responsible for managing complex liability claims, employment & civil rights claims to their conclusion in the most cost-effective way possible for the client. In addition, the Sr. Claims Examiner will be responsible for recognizing claims involving coverage issues a ...
-
Temporary Claims Examiner I
3 weeks ago
Partnership HealthPlan of California Fairfield, United StatesOverview: · To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider commun ...
Workers Compensation Claims Examiner - Concord, United States - Sedgwick
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. 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
Workers Compensation Claims Examiner | Concord, CA (Hybrid)
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?
OFFICE LOCATIONS
Concord, CA (Hybrid)
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
Education & Licensing
Bachelor's degree 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. **Must have experience managing California Workers Compensation claims.**
Licensing / Jurisdiction Knowledge:
TAKING CARE OF YOU
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 $70,000 - $99,000. 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.
#claimsexaminer #claims
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.
