Hispanic Alliance for Career Enhancement
R67623 | Workers Compensation | Claims Examiner | Hybrid - Long Beach, CA
Hispanic Alliance for Career Enhancement, Long Beach, California, us, 90899
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.
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 Long Beach, CA or Roseville, CA (Hybrid)
Primary Purpose To analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high‑exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and identify subrogation of claims and negotiate settlements.
Essential Functions and Responsibilities
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; settles claims within designated authority level.
Prepares necessary state filings 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.
Additional Functions and Responsibilities
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
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 claims management experience or an equivalent combination of education and experience required.
Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line‑of‑business handled, recoveries offsets and deductions, claim and disability duration, cost‑containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line‑of‑business.
Excellent oral and written communication, including presentation skills.
PC literate, including Microsoft Office products.
Analytical and interpretive skills.
Strong organizational skills.
Good interpersonal skills.
Excellent negotiation skills.
Ability to work in a team environment.
Ability to meet or exceed Service Expectations.
Work Environment When applicable and appropriate, consideration will be given to reasonable accommodations.
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, travel as required.
Auditory/Visual Hearing, vision, and talking.
Notice Credit security clearance, confirmed via a background credit check, is required for this position.
Compensation & Benefits The range of starting pay for this role is $80,000 – $105,000. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
EEO Statement Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with relevant Fair Chance Ordinances and applicable laws.
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.
When your experience doesn't perfectly align with every qualification, consider applying anyway—Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience, and may be the right candidate for this or other roles.
#J-18808-Ljbffr
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 Long Beach, CA or Roseville, CA (Hybrid)
Primary Purpose To analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high‑exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and identify subrogation of claims and negotiate settlements.
Essential Functions and Responsibilities
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; settles claims within designated authority level.
Prepares necessary state filings 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.
Additional Functions and Responsibilities
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
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 claims management experience or an equivalent combination of education and experience required.
Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line‑of‑business handled, recoveries offsets and deductions, claim and disability duration, cost‑containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line‑of‑business.
Excellent oral and written communication, including presentation skills.
PC literate, including Microsoft Office products.
Analytical and interpretive skills.
Strong organizational skills.
Good interpersonal skills.
Excellent negotiation skills.
Ability to work in a team environment.
Ability to meet or exceed Service Expectations.
Work Environment When applicable and appropriate, consideration will be given to reasonable accommodations.
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, travel as required.
Auditory/Visual Hearing, vision, and talking.
Notice Credit security clearance, confirmed via a background credit check, is required for this position.
Compensation & Benefits The range of starting pay for this role is $80,000 – $105,000. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
EEO Statement Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with relevant Fair Chance Ordinances and applicable laws.
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.
When your experience doesn't perfectly align with every qualification, consider applying anyway—Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience, and may be the right candidate for this or other roles.
#J-18808-Ljbffr