Workers Compensation Claims Adjuster

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 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, there's no limit to what you can achieve.

We're looking for a Workers Compensation Claims Adjuster to join our team in Brea, CA. As a global industry leader, we need someone who can bring their big ideas to help solve problems for some of the world's best brands.

Primary Purpose: Analyze mid- and higher-level workers compensation claims to determine benefits due; ensure ongoing adjudication of claims within company standards and industry best practices; and identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities:

• Manage workers compensation claims determining compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agency.
• Develop and manage workers compensation claims' action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
• Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract.
• Manage subrogation of claims and negotiate settlements.
• Communicate claim action with claimant and client.
• Ensure 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.
• Maintain professional client relationships.

Additional Functions and Responsibilities:

• Perform other duties as assigned.
• Support the organization's quality program(s).
• Travel as required.

Qualifications:

• Bachelor's degree from an accredited college or university preferred.
• Three (3) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
• California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.

Benefits:

• 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.

Work Environment Requirements:

• 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.
• Auditory/Visual: Hearing, vision, and talking.

The salary range for this role is $73,000 - 85,000 per year.