Workers Compensation Claims Adjuster | Rancho Cucamonga, CA

• 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

Rancho Cucamonga, CA - Hybrid
 

PRIMARY PURPOSE OF THE ROLE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Manages workers’ compensation claims, including determining compensability and benefits, developing action plans, monitoring reserve accuracy, and ensuring timely resolution in accordance with claim or client contracts.

• Processes and approves claim payments, coordinates return-to-work efforts, manages subrogation, and negotiates settlements.
• Communicates claim activity with claimants and clients while maintaining strong professional relationships.
• Ensures accurate claim documentation, coding, and required state and physician filings.
• May handle complex lifetime or defined-period medical claims, including utilization review treatment decisions.

QUALIFICATIONS

Education & Licensing: 4 years of claims management experience or equivalent combination of education and experience required.

• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. 

• Professional certification as applicable to line of business preferred.

Licensing / Jurisdiction Knowledge: California workers' compensation claims handling experience | SIP certified preferred

TAKING CARE OF YOU

• 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.

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. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $70,000-$80,000/yr. 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.

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