Claims Adjuster - Workers Compensation (West Hills,CA/Remote 3 days)

📋 Description

• • Adjudicate complex workers compensation claims to determine compensability and benefits due, ensuring alignment with company standards and industry best practices.
• • Manage long-term indemnity claims by monitoring reserve accuracy and filing required documentation with state agencies.
• • Develop and execute action plans for claims resolution, including coordination of return-to-work efforts and approval of claim payments.
• • Approve and process assigned claims based on claim-specific details and client contract terms.
• • Identify, manage, and negotiate subrogation opportunities to recover costs on eligible claims.
• • Communicate clearly and professionally with claimants and clients regarding claim status, decisions, and next steps.
• • Work in a hybrid model with three days per week remote and two days in the West Hills, CA office.
• • Apply knowledge of California workers compensation jurisdictional rules and regulations to all claim decisions.
• • Maintain compliance with all state and federal regulations governing workers compensation claims handling.
• • Utilize Sedgwick’s global network of experts to enhance claim resolution strategies and share best practices.
• • Leverage professional development opportunities to advance skills and grow within the claims management field.
• • Operate with autonomy and flexibility in daily workflow while maintaining accountability for claim outcomes.
• • Ensure timely and accurate documentation of all claim activities in company systems.
• • Collaborate with internal teams to resolve complex claims and support client service objectives.
• • Uphold Sedgwick’s core values of empathy, accountability, collaboration, growth, and inclusion in all interactions.
• • Participate in ongoing training to maintain licensure and stay current with evolving workers compensation laws.
• • Contribute to a culture of excellence in customer service for clients representing diverse industries.
• • Support the company’s mission to assist individuals facing unexpected injuries through fair and efficient claims resolution.