Workers Compensation Claims Examiner | Long Beach, CA (Hybrid Schedule) | SIP Re
Hispanic Alliance for Career Enhancement, Long Beach, CA, United States
Workers Compensation Claims Examiner
Location: Long Beach, CA.
Schedule: Hybrid – 2 days in-office / 3 days work from home.
Primary Purpose of the Role
We are looking for driven individuals who embody our caring count model and core values, including empathy, accountability, collaboration, growth, and inclusion.
Essential Responsibilities
Analyze and process complex or technically difficult workers’ compensation claims, investigating and gathering information to determine claim exposure.
Manage claims through well‑developed action plans to timely and appropriate resolution.
Negotiate settlement of claims within designated authority.
Calculate and assign timely and appropriate reserves; manage reserve adequacy throughout the claim life cycle.
Calculate and pay benefits due, approve and issue claim payments and adjustments, and settle claims within authority limits.
Prepare necessary state filings within statutory limits.
Manage the litigation process, ensuring timely and cost‑effective resolution.
Coordinate vendor referrals for additional investigation or litigation management.
Use cost‑containment techniques, including strategic vendor partnerships, to reduce overall claim costs.
Manage claim recoveries such as subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Report claims to the excess carrier; respond to requests of directions professionally and promptly.
Communicate claim activity and processing with the claimant and client, maintaining professional client relationships.
Ensure claim files are properly documented and claim coding is correct.
Refer cases as appropriate to supervisor and management.
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.
Professional certification applicable to the line of business preferred.
Five (5) years of claims management experience or an equivalent combination of education and experience.
Knowledge of CA jurisdiction.
Licensing: SIP.
Benefits
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering, including medical, dental, vision, 401(k) on day one, PTO, disability, life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits.
Reasonable compensation range for this role: $72,914.00–$90,000.00 (CA).
Equal Opportunity Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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Location: Long Beach, CA.
Schedule: Hybrid – 2 days in-office / 3 days work from home.
Primary Purpose of the Role
We are looking for driven individuals who embody our caring count model and core values, including empathy, accountability, collaboration, growth, and inclusion.
Essential Responsibilities
Analyze and process complex or technically difficult workers’ compensation claims, investigating and gathering information to determine claim exposure.
Manage claims through well‑developed action plans to timely and appropriate resolution.
Negotiate settlement of claims within designated authority.
Calculate and assign timely and appropriate reserves; manage reserve adequacy throughout the claim life cycle.
Calculate and pay benefits due, approve and issue claim payments and adjustments, and settle claims within authority limits.
Prepare necessary state filings within statutory limits.
Manage the litigation process, ensuring timely and cost‑effective resolution.
Coordinate vendor referrals for additional investigation or litigation management.
Use cost‑containment techniques, including strategic vendor partnerships, to reduce overall claim costs.
Manage claim recoveries such as subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Report claims to the excess carrier; respond to requests of directions professionally and promptly.
Communicate claim activity and processing with the claimant and client, maintaining professional client relationships.
Ensure claim files are properly documented and claim coding is correct.
Refer cases as appropriate to supervisor and management.
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.
Professional certification applicable to the line of business preferred.
Five (5) years of claims management experience or an equivalent combination of education and experience.
Knowledge of CA jurisdiction.
Licensing: SIP.
Benefits
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering, including medical, dental, vision, 401(k) on day one, PTO, disability, life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits.
Reasonable compensation range for this role: $72,914.00–$90,000.00 (CA).
Equal Opportunity Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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