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Sedgwick · 1 week ago

Workers Compensation Claims Adjuster | Dedicated Account | Rancho Cordova (Hybrid)

Rancho Cordova, CA

Full-time

Hybrid

Mid Level

$60K/yr - $80K/yr

4+ years exp

Sedgwick is a global industry leader recognized for its excellence and customer service, providing a caring culture and work-life balance. The Workers Compensation Claims Adjuster role involves analyzing and managing workers compensation claims, determining benefits due, and negotiating settlements while ensuring compliance with company standards and industry best practices.

BankingInsuranceRisk Management

Hiring Manager

Amy MacPherson

Responsibilities

Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency

Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments

Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract

Manages subrogation of claims and negotiates settlements

Communicates claim action with claimant and client

Ensures 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

Maintains professional client relationships

Performs other duties as assigned

Supports the organization's quality program(s)

Travels as required

Qualification

California Workers CompensationClaims ManagementSIP CertificationNegotiation SkillsEmpathyAccountabilityInclusionCollaborationGrowth Mindset

Required

Four (4) years of California Workers Compensation claims management experience or equivalent combination of education and experience

California jurisdictional knowledge

SIP required or must be obtained within one (1) year of employment

Preferred

Bachelor's degree from an accredited college or university

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.

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.