worker's compensation claims examiner

Sedgwick

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Claims Team Lead - Workers Compensation | Roseville or San Diego, CA
<div><p>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&rsquo;s best brands?
</p></div><div><ul><li><p>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</p></li><li><p>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</p></li><li><p>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</p></li><li><p>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</p></li><li><p>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</p></li><li><p>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</p></li><li><p>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</p></li></ul><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>OFFICE LOCATIONS
</b><br>
Roseville, CA (Hybrid)
</p><p>San Diego, CA (Hybrid)
</p></div><p></p><p><b>PRIMARY PURPOSE: </b>To supervise the operation of workers compensation examiners for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
</p><p></p><p><b>ESSENTIAL FUNCTIONS and RESPONSIBILITIES
</b></p><ul><li>Supervises a team of examiners; may delegate some duties to others within the unit.
</li><li>Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
</li><li>Provides technical/jurisdictional direction to examiner reports on claims adjudication.
</li><li>Compiles reviews and analyzes management reports and takes appropriate action.
</li><li>Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
</li><li>Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
</li><li>Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
</li><li>Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
</li><li>Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
</li><li>Assures that direct reports are properly licensed in the jurisdictions serviced.
</li><li>Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
</li></ul><p></p><p><b>SUPERVISORY RESPONSIBILITIES
</b></p><ul><li>Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
</li><li>Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
</li><li>Provides support, guidance, leadership and motivation to promote maximum performance.
</li></ul><p></p><p><b>QUALIFICATIONS
</b></p><p></p><p><b>Education &amp; Licensing
</b></p><p>Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
</p><p></p><p><b>Experience
</b></p><p>Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
</p><p></p><p><b>Licensing / Jurisdiction Knowledge: </b>California workers compensation claims handling experience | SIP Certified
</p><p></p><p><b>TAKING CARE OF YOU
</b></p><ul><li><p>Flexible work schedule
</p></li><li><p>Career development
</p></li><li><p>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one
</p></li></ul><p></p><p>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 $100,000-$115,000/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.
</p><p></p><p>#Claims #Supervisor #Hybrid #LI-Hybrid #LI-Remote #LI-AM
</p><p></p><p>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&rsquo; 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.
</p><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Claims Team Lead - Workers Compensation | Roseville or San Diego, CA

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions
<p></p><div><p>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&rsquo;s best brands?
</p><ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.
</li></ul><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>To analyze <b>Lost-Time Workers Compensation ( </b>litigated, subrogation, high exposure/severe cases) claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
</p><p></p><p><b>PRIMARY PURPOSE OF THE ROLE: </b>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</b></p><ul><li>Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
</li><li>Negotiating settlement of claims within designated authority.
</li><li>Communicating claim activity and processing with the claimant and the client.
</li><li>Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
</li></ul><p></p><p><b>QUALIFICATIONS
</b></p><ul><li>Education &amp; Licensing: 2-3 years of claims management experience or equivalent combination of education and experience required.
</li><li>High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
</li><li>Professional certification as applicable to line of business preferred.
</li></ul><p></p><p><b>Jurisdiction Knowledge: NJ, PA, VA, DE
</b></p><p><b>Licensing: DE preferred, not required
</b></p><p></p><p><b>TAKING CARE OF YOU
</b></p><ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Opportunity to work in an agile environment.
</li><li>Career development and promotional growth opportunities.
</li></ul><p></p><p>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 (75,000 - 90,000). 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.
</p></div><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions

CCMSI

<div>Overview:
<div><b>
Position Title:</b> Workers' Compensation Claim Consultant (MA, CT, RI)<br>
<b>Location:</b> Reading, MA (hybrid preferreed, remote considered)<br>
<b>Schedule:</b> 8:00 am-4:00 pm ET<br>
<b>Salary Range:</b> $75,000-$85,000</div><p></p><h3 class="jobSectionHeader"><b>
Build Your Career With Purpose at CCMSI</b></h3><div>
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.</div><div></div><div><br>
We don&rsquo;t just process claims&mdash;we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work&reg;, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.</div><h3 class="jobSectionHeader"><b>
Job Summary</b></h3><div></div><div><br>
We are seeking an experienced and highly skilled <b>Workers&rsquo; Compensation Claim Consultant</b> to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands‑on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions. As a Claim Consultant, you will play a key role in delivering exceptional service to CCMSI clients and upholding our high standards of quality and responsiveness.</div><div>
</div><div><div><i>
This is a full life‑cycle WC adjuster position within a TPA environment, and only candidates with proven Workers&rsquo; Compensation claims experience will be considered.</i></div></div><br>
<div></div>
Responsibilities:
<div>
When we hire Workers&rsquo; Compensation Adjusters at CCMSI, we look for detail‑driven problem‑solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.</div><ul><li>
Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.</li><li>
Establish reserves and/or provide reserve recommendations within established reserve authority levels.</li><li>
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.</li><li>
Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.</li><li>
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.</li><li>
Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)</li><li>
Assess and monitor subrogation claims for resolution.</li><li>
Review and maintain personal diary on claim system.</li><li>
Client satisfaction.</li><li>
Prepare reports detailing claim status, payments and reserves, as requested.</li><li>
Compute disability rates in accordance with state laws.</li><li>
Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.</li><li>
Prepare newsletter articles, as requested.</li><li>
Provide notices of qualifying claims to excess/reinsurance carriers.</li><li>
Handle more complex and involved claims than lower level claim positions with minimum supervision.</li><li>
Conduct claim reviews and/or training sessions for designated clients, as requested.</li><li>
Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.</li><li>
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.</li></ul><br>
<div></div>
Qualifications:<div></div><div><h2 class="jobSectionHeader"><b><br>
Required Qualifications</b></h2><ul><li><b>
Five or more years of Workers&rsquo; Compensation claims experience.</b></li><li>
Proficiency with Microsoft Office products, including Word, Excel, and Outlook.</li><li>
Adjuster&rsquo;s license may be required based on jurisdiction.</li><li><b>
Experience handling CT and RI workers' compensation claims required.</b></li></ul><h2 class="jobSectionHeader"><b>
Preferred Qualifications</b></h2><ul><li>
Bachelor&rsquo;s degree is preferred but not required.</li><li><b>
Bilingual (Spanish) proficiency</b> &mdash; highly valued for communicating with claimants, employers, or vendors, but not required.</li></ul><div><b>
Why You&rsquo;ll Love Working Here</b></div><div></div><ul><li><b><br>
4 weeks </b><b><i>(Paid time off that accrues throughout the year in accordance with company policy)</i></b><b> + 10 paid holidays in your first year</b></li><li><b>
Comprehensive benefits</b>: Medical, Dental, Vision, Life, and Disability Insurance</li><li><b>
Retirement plans</b>: 401(k) and Employee Stock Ownership Plan (ESOP)</li><li><b>
Career growth</b>: Internal training and advancement opportunities</li><li><b>
Culture</b>: A supportive, team-based work environment</li></ul><div></div><div><b><br>
How We Measure Success</b></div><div></div><div><br>
 At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
</div><ul><li><b>Quality claim handling</b> &ndash; thorough investigations, strong documentation, well-supported decisions</li><li><b>
Compliance &amp; audit performance</b> &ndash; adherence to jurisdictional and client standards</li><li><b>
Timeliness &amp; accuracy</b> &ndash; purposeful file movement and dependable execution</li><li><b>
Client partnership</b> &ndash; proactive communication and strong follow-through</li><li><b>
Professional judgment</b> &ndash; owning outcomes and solving problems with integrity</li><li><b>
Cultural alignment</b> &ndash; believing every claim represents a real person and acting accordingly</li></ul><div><b><i>
This is where we shine, and we hire adjusters who want to shine with us.</i></b></div><div></div><div><b><i><br>
Compensation &amp; Compliance</i></b></div><div><i>
The posted salary reflects CCMSI&rsquo;s good-faith estimate in accordance with applicable pay transparency laws. </i><i>Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.</i></div><div></div><div><i><br>
CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.</i></div><div></div><div><b><i><br>
Visa Sponsorship:</i></b><i> CCMSI does not provide visa sponsorship for this position.</i><br>
<b><i>ADA Accommodations:</i></b><i> CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.</i><br>
<b><i>Equal Opportunity Employer:</i></b><i> CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.</i></div><div></div><div><i><br>
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.</i></div><div></div><div><b><br>
Our Core Values</b></div><div></div><div><br>
At CCMSI, we believe in doing what&rsquo;s right&mdash;for our clients, our coworkers, and ourselves. We look for team members who:</div><div></div><ul><li><b><br>
Lead with transparency </b>We build trust by being open and listening intently in every interaction.
</li><li><b>Perform with integrity </b>We choose the right path, even when it is hard.
</li><li><b>Chase excellence </b>We set the bar high and measure our success. What gets measured gets done.
</li><li><b>Own the outcome </b>Every employee is an owner, treating every claim, every decision, and every result as our own.
</li><li><b>Win together </b>Our greatest victories come when our clients succeed.</li></ul><p></p><div><b><br>
We don&rsquo;t just work together&mdash;we grow together. If that sounds like your kind of workplace, we&rsquo;d love to meet you.</b></div><div></div><div><br>
#CCMSICareers #EmployeeOwned #GreatPlaceToWorkCertified #ESOP #TPA #InsuranceCareers #ClaimsCareers #IND123 #LI-Hybrid #WorkersCompensation #RhodeIsland #Connecticut #Massachusetts</div></div></div><div></div>

Workers' Compensation Claim Consultant

TEEMA Group

<div><h3 class="jobSectionHeader"><b>Role Summary</b></h3><p>
The Workers&rsquo; Compensation Claims Supervisor is a key leadership role responsible for guiding and overseeing a high-performing claims team in a fast-paced, compliance-focused environment. This position offers the opportunity to combine deep technical expertise in Texas workers&rsquo; compensation with hands-on leadership, mentorship, and client engagement. The Supervisor ensures accurate claims handling, regulatory compliance, exceptional service delivery, and continuous professional development of staff, while serving as a trusted resource for clients and internal partners.</p><p>
This is an ideal opportunity for an experienced claims leader who thrives in an in-office setting, values accountability and collaboration, and enjoys driving both operational excellence and team success.
</p><h3 class="jobSectionHeader"><b>Key Duties &amp; Responsibilities</b></h3><ul><li><p>
Supervise, mentor, and support Claims Examiners, Claims Assistants, and administrative staff</p></li><li><p>
Monitor attendance, performance, evaluations, and address disciplinary matters as needed</p></li><li><p>
Review claims activity, including initial reviews, ongoing case management, delays, and denials</p></li><li><p>
Approve reserve changes up to $250,000 and payments up to $10,000 in accordance with internal guidelines</p></li><li><p>
Conduct comprehensive file reviews to ensure compliance with Texas workers&rsquo; compensation laws, client requirements, and internal procedures</p></li><li><p>
Coordinate and lead training sessions related to regulatory updates, internal policies, and best practices</p></li><li><p>
Ensure caseloads are appropriately staffed, balanced, and managed efficiently</p></li><li><p>
Approve priority payments and sign checks as required</p></li><li><p>
Respond professionally and promptly to claimant, vendor, and client inquiries or concerns</p></li><li><p>
Monitor vendor performance and recommend or implement panel adjustments as necessary</p></li><li><p>
Ensure all client servicing instructions are consistently followed</p></li><li><p>
Provide coverage for claims examiners during absences or vacancies</p></li><li><p>
Prepare, review, and evaluate monthly client reports</p></li><li><p>
Facilitate and participate in internal and external audits</p></li><li><p>
Conduct and document educational and training sessions for internal teams and external stakeholders</p></li><li><p>
Attend client file reviews and meetings as needed</p></li><li><p>
Collaborate with leadership and sales/service teams on RFPs and client service initiatives</p></li><li><p>
Adhere to Supervisor Best Practice Guidelines</p></li><li><p>
Perform additional duties as assigned to support operational and organizational goals</p></li></ul><h3 class="jobSectionHeader"><b>
Required Qualifications</b></h3><ul><li><p>
High School Diploma or GED</p></li><li><p>
Minimum of 5 years of supervisory experience within workers&rsquo; compensation claims</p></li><li><p>
Active Texas Adjuster&rsquo;s License</p></li><li><p>
Strong working knowledge of Texas workers&rsquo; compensation statutes and regulations</p></li><li><p>
Solid understanding of medical terminology</p></li><li><p>
Proven experience supervising claims staff in a high-volume environment</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
Desired Qualifications</b></h3><ul><li><p>
Bachelor&rsquo;s degree in a related field</p></li><li><p>
Experience handling Texas public entity and school district claims (highly preferred)</p></li><li><p>
Strong analytical and problem-solving capabilities</p></li><li><p>
Ability to manage diary systems, prioritize workload, and meet strict deadlines</p></li><li><p>
Excellent written and verbal communication skills</p></li><li><p>
Ability to clearly explain complex claims information to claimants, clients, and staff</p></li><li><p>
Proficiency in Microsoft Word and Excel</p></li><li><p>
Demonstrated ability to manage and mentor employees with varying experience levels</p></li><li><p>
Strong interpersonal, leadership, and coaching skills</p></li><li><p>
Ability to manage stress, multitask effectively, and maintain focus in a deadline-driven environment</p></li><li><p>
Positive, professional attitude with a strong sense of urgency and accountability</p></li></ul><h3 class="jobSectionHeader"><b>
About the Organization</b></h3><p>
This opportunity is with a well-established organization specializing in workers&rsquo; compensation and claims administration services. The organization is committed to regulatory excellence, client satisfaction, and fostering a collaborative, professional work environment that supports growth, leadership development, and long-term career success.
</p><h3 class="jobSectionHeader"><b>Location &amp; Work Type</b></h3><ul><li><p><b>
Location:</b> Irving, Texas</p></li><li><p><b>
Work Type:</b> On-site, in-office role</p></li></ul>
#Workwolf</div>

Workers’ Compensation Claims Supervisor

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Claims Team Lead - Workers Compensation | Brea, CA
<div><div>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&rsquo;s best brands?
</div></div><div><div><div><div><div><div><div><div><div><ul><li><p>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</p></li><li><p>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</p></li><li><p>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</p></li><li><p>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</p></li><li><p>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</p></li><li><p>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</p></li><li><p>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</p></li></ul><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>OFFICE LOCATIONS
</b></p><p>Brea, CA - Hybrid (3 days in office, 3 days remote)
</p><p></p><p><b>PRIMARY PURPOSE OF THE ROLE: </b>Oversees multiple teams of examiners and technical staff handling workers compensation claims for clients. Manages workloads, provides training, and monitors individual claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex or high-exposure case.
</p><p></p><p><b>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</b></p><ul><li><p>Supervises multiple teams of examiners and technical operations colleagues, delegating duties as needed and ensuring proper licensing and documentation standards.
</p></li><li><p>Provides technical and jurisdictional guidance on claims adjudication, including quality reviews and reserve evaluations for high-cost or complex claims.
</p></li><li><p>Acts as a second-level appeal authority for client and claimant issues, implementing final decisions.
</p></li><li><p>Identifies trends, issues, and opportunities for process improvement; advises management and coordinates related projects.
</p></li><li><p>Monitors third-party and sensitive claims, including litigated and vocational rehabilitation cases.
</p></li><li><p>Maintains professional client relationships, offering recommendations and written summaries as needed.
</p></li><li><p>Ensures accurate claim coding and documentation by examiners.
</p></li></ul><p></p><p><b>QUALIFICATIONS
</b></p><p>Education &amp; Licensing: 6 years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
</p><ul><li><p>High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
</p></li><li><p>Professional certification as applicable to line of business preferred.
</p></li></ul><p></p><p><b>Licensing / Jurisdiction Knowledge: </b>California workers compensation claim handling experience | SIP Certified
</p><p></p><p><b>TAKING CARE OF YOU
</b></p><ul><li><p>Flexible work schedule.
</p></li><li><p>Referral incentive program.
</p></li><li><p>Career development and promotional growth opportunities.
</p></li><li><p>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</p></li></ul><p></p><p>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 $105,000-$115,000/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.
</p><p></p><p>#LI-GC1 #LI-Hybrid #claims #claimsteamlead
</p></div></div></div></div></div></div></div></div></div><p></p><p>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&rsquo; 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.
</p><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Claims Team Lead - Workers Compensation | Brea, CA

Zurich Insurance

<div><div>Zurich is seeking an experienced Workers&rsquo; Compensation Claims Specialist to join our team! This will be a hybrid role based out of our Las Vegas, NV office, or remote in the U.S for those with expertise in handling Jurisdiction of NV.</div><div></div><div><br>
The Sr. Workers&rsquo; Compensation Claims Specialist will handle multi-party personal or commercial line Workers&rsquo; Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.</div><div></div><div><br>
In this role you will be responsible for:</div><br>
<div></div><ul><li>
Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.</li><li>
Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.</li><li>
Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.</li><li>
Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.</li><li>
Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.</li><li>
Assess damages by calculating applicable damages or range of damages allowed by law.</li><li>
Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.</li><li>
Meet quality standards by following best practices</li></ul><div></div><div><br>
Basic Qualifications:</div><br>
<div></div><ul><li>
Bachelor&rsquo;s Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.<br>
AND</li><li>
Must obtain and maintain required adjuster license(s)</li><li>
Microsoft Office experience</li><li>
Knowledge of insurance regulations, markets and products</li></ul><div></div><div><br>
Preferred Qualifications:</div><br>
<div></div><ul><li>
6+ experience handling high severity Workers Compensation claims
</li><li>6+ years of experience in litigation management</li><li>
Must have Jurisdiction expertise handling state of Nevada</li><li>
Effective verbal and written communication skills</li><li>
Strong analytical, critical thinking and problem-solving skills</li><li>
Strong multi-tasking and prioritization skills</li><li>
Experience collaborating in a team environment and building cross functional working relationships</li><li>
Proactively shares and promotes sharing of insights</li><li>
Ability to gather unique perspectives from other teams/functions to optimize outcomes.</li><li>
Understands, analyzes, and applies the component parts of an insurance policy for complex claims</li><li>
Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims</li><li>
Ability to determine the scope and exposure for complex claims</li><li>
Ability to leverage trend and relationships to provide high-quality customer service</li><li>
Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.</li><li>
Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims</li><li>
Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies</li></ul><p></p><p><br>
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply&mdash;your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $72,100.00 - $117,900.00, with short-term incentive bonus eligibility set at 15%.</p><p></p><p><br>
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]</p><p></p><p><b><br>
Why Zurich?</b></p><p>
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment&mdash;so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500&reg;.</p><p></p><p><br>
Join us for a brighter future&mdash;for yourself and our customers.</p><p></p><p><br>
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.</p><p></p><p><br>
Zurich complies with 18 U.S. Code &sect; 1033.</p><p></p><p><b><br>
Please note:</b> Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.</p><p>
Location(s): AM - Nevada Virtual Office<br>
Remote Working: No<br>
Schedule: Full Time<br>
Employment Sponsorship Offered: No<br>
<br>
Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID</p></div>

Sr. Claims Specialist (Workers Compensation)

National Interstate

<div><p>National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you!</p><p></p><p>
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.</p><p></p><p><b>
Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. </b><b>(https://natl.com/)</b></p><p></p><p><b>
National Interstate</b><b> is looking for a </b><b>Workers Comp Senior Claims Representative to</b><b> join their team. This individual will either work hybrid from the Richfield, OH office </b><b>4 days per week</b><b> or work fully remote from the USA, if not local to the office.</b></p><p></p><p><b>
National Interstate&rsquo;s </b><b>culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in‑office days are Tuesday&ndash;Thursday, with the fourth day determined by business needs.</b></p><p></p><p><b>
Essential Job Functions and Responsibilities</b></p><ul><li>
Manages an inventory of claims to evaluate compensability/liability.</li><li>
Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages.</li><li>
Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.</li><li>
Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.</li><li>
Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.</li><li>
Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.</li><li>
Performs other duties as assigned.</li></ul><p></p><p><b>
Job Requirements</b></p><h3 class="jobSectionHeader"><b>
Education: </b><b>Bachelor&rsquo;s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.</b></h3><h3 class="jobSectionHeader"><b>
Experience: </b><b>Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).</b></h3><p><b>
Prefer PA NJ MA state handling experience</b></p><p></p><h3 class="jobSectionHeader"><b>
Scope of Job/Qualifications: </b><b>Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion.</b></h3><p></p><p>
This job is non-exempt in California and Washington</p><p></p><p><b>
Company:</b></p>
NIIC National Interstate Insurance Company<p></p><p><b><br>
Salary Range:</b></p>
$70,000.00 -$75,000.00<p></p><p><b>
Benefits:
</b></p><p>We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.</p><p></p><p><br>
Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.</p><p></p><ul><li><br>
<b>Excludes seasonal employees and interns.</b></li></ul></div>

Workers Comp Senior Claims Representative

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