Sedgwick · Brea, CAPrepare for this interview
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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. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | CA Jurisdiction Knowledge Required | Brea, CA 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 Brea, CA - Hybrid (2 days onsite) PRIMARY PURPOSE : To process future medical workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Processes future medical 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 coordinates workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments. Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract. Administers 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 low-level 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.
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