Top 16 Claims examiner Jobs in Roseville, Ca

Claims Examiner - Workers Comp (Hybird Roseville, CA)
Sedgwick —Roseville, CA
- 5 years
- Computer literacy
- Writing skills
- Health savings account
- Disability insurance
Workers Compensation Claims Examiner | Dedicated Account | 3 Days Remote
Sedgwick —Roseville, CA
- Hybrid work
- 5 years
- Office
- Bachelor's degree
- Health savings account
- Disability insurance
Workers Compensation Claims Examiner | Long Beach or Roseville, CA (Hybrid)
Sedgwick —Roseville, CA
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Health savings account
- Disability insurance
Examiner Physician Assistant
Loyal Source Government Services —Rocklin, CA
- $64.69 an hour
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Nurse Practitioner
Loyal Source Government Services —Rocklin, CA
- $149,572 - $179,572 a year
- Monday to Friday
- Microsoft Word
- Nursing
- Microsoft Outlook
Quick Apply
Workers' Compensation Claims Examiner (SIP) - 44846
IOS Staffing Services —Rancho Cordova, CA
- $85,000 - $95,000 a year
- Full-time
- Hybrid work
- Background check
- 5 years
- Office
- Health insurance
- Dental insurance
Quick Apply
6d
Claims Examiner Trainee (Spanish Fluency Preferred)
Berkshire Hathaway Homestate Companies —Sacramento, CA
- Hybrid work
- Spanish
- Writing skills
- Office
- Free parking
- AD&D insurance
Quick Apply
General Liability Litigation Examiner
Sedgwick —Roseville, CA
- Hybrid work
- 6 years
- Customer service
- Mid-level
- Health savings account
- Disability insurance
Appeals Examiner - West Sacramento, CA
Gainwell Technologies —West Sacramento, CA
- $37,500 - $53,500 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Travel reimbursement
- Profit sharing

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Workers Compensation Claims Examiner | Dedicated Account | 3 Days Remote
Sedgwick —Roseville, CA
Prepares necessary state fillings within statutory limits. Professional certification as applicable to line of business preferred.

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Account Examiner 2 - (PN: 20067467)
State of Ohio - Workers' Compensation —Columbus, OH
There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
$23.65 an hour
1d
Security Officer Enhanced Part Time Screening Examiner
Allied Universal —Columbus, OH
A valid driver’s license will be required for driving positions only. As a condition of employment, applicants will be subject to a background investigation in…
$19.75 an hour
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2d

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Claims Examiner - Workers Comp (Hybird Roseville, CA)

Sedgwick -
Roseville, CA

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Job Details

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Insurance claims inquiry response
Computer operation
Customer relationship building
Insurance claims settlement negotiation
Medicare
Claims payment authorization
5 years
Insurance dispute resolution
Computer literacy
Writing skills
Presentations for conferences or internal meetings
Claims negotiation
Mid-level
Client relationship development
Workers' compensation insurance knowledge
Analysis skills
Bachelor's degree
Insurance regulation
Medicare regulations
Task prioritization
Client management
Coordinating with insurance clients
Desktop applications
Vendor relationship management
Vendor communication
Organizational skills
Medical management
Productivity software
Case referral
Insurance claims status tracking

Full Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®
Most Loved Workplace®
Forbes Best-in-State Employer

Claims Examiner - Workers Comp (Hybird Roseville, CA)

PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to 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; and settles clams within designated authority level.
Prepares necessary state fillings 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.

QUALIFICATION

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 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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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 $80-85K . 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

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

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.

Apply Now

Refine Your Search

claims examiner jobs in roseville, ca

Claims Examiner - Workers Comp (Hybird Roseville, CA)

Workers Compensation Claims Examiner | Dedicated Account | 3 Days Remote

Workers Compensation Claims Examiner | Long Beach or Roseville, CA (Hybrid)

Examiner Physician Assistant

Examiner Nurse Practitioner

Workers' Compensation Claims Examiner (SIP) - 44846

Claims Examiner Trainee (Spanish Fluency Preferred)

General Liability Litigation Examiner

Appeals Examiner - West Sacramento, CA

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