Claims Examiner, Sr. jobs in San Diego, CA

Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

S
Workers Compensation Claims Examiner | Must Reside in California
  • Sedgwick Claims Management Services Inc.
  • San Diego, CA FULL_TIME
  • 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 Workers Compensation Claims Examiner | Must Reside in California 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’s best brands? 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 Remote within California San Diego, CA (Hybrid) 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. 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. SALARY TRANSPARENCY – CO, NY, WA, CA 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 $77,602 - $99,774. 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. #claimsexaminer #claims 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. Taking care of people is at the heart of everything we do. Caring counts Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us.
  • 21 Days Ago

A
Mobile Examiner
  • APPS San Diego
  • San Diego, CA PART_TIME
  • We are a local branch of a national healthcare company that seeks a California Licensed Phlebotomist (CPT) or LVN w/ Blood withdrawal certification for a Mobile Medical Examiner position. We are the l...
  • 18 Days Ago

C
Deputy Medical Examiner I-23415808
  • County of San Diego
  • San Diego, CA FULL_TIME
  • The County of San Diego Medical Examiner's Department is currently recruiting for Deputy Medical Examiners.Deputy Medical Examiners determine the cause of death for the deceased in the custody of the ...
  • 2 Days Ago

C
Deputy Medical Examiner II-23415908
  • County of San Diego
  • San Diego, CA FULL_TIME
  • The County of San Diego Medical Examiner's Department is currently recruiting for Deputy Medical ExaminersBoard-certified Forensic Pathologists with non-forensic subspecialty training (i.e., Neuropath...
  • 2 Days Ago

T
Mobile Medical Examiner
  • Talon & Family Inc
  • San Diego, CA PART_TIME
  • We are a local branch of a national healthcare company that seeks a California Licensed Phlebotomist or LVN w/ Blood withdrawal certification for a Mobile Medical Examiner position. We are the largest...
  • 8 Days Ago

L
Network and Computer Forensics Examiner
  • Longeviti, LLC
  • San Diego, CA FULL_TIME
  • Longeviti seeks a Network and Computer Forensics Examiner to provide mission support for The Naval Criminal Investigative Service (NCIS) in San Diego, CA. This position will provide detailed forensic ...
  • 9 Days Ago

Filters

Clear All

Filter Jobs By Location
  • Filter Jobs by companies
  • More

0 Claims Examiner, Sr. jobs found in San Diego, CA area

T
HR Risk & Safety Supervisor
  • Talent Acquisitions Group Inc
  • San Marcos, CA
  • Title: HR Risk & Safety Supervisor Location: San Marcos, CA (Onsite) Industry: Food Service, Retail Food Compensation: H...
  • 3/28/2024 12:00:00 AM

S
Claims Representative - IAP (On-Site San Diego, CA)
  • Sedgwick
  • San Diego, CA
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 3/27/2024 12:00:00 AM

P
Administrative Assistant
  • PrideStaff
  • San Marcos, CA
  • Job Description Job Description PrideStaff has an excellent temp to hire opportunity in San Marcos, CA Administrative As...
  • 3/27/2024 12:00:00 AM

P
Claims Service Representative III -Casualty
  • Pleasant Holidays, LLC
  • Escondido, CA
  • **Claims Service Representative III -Casualty** **Primary Location:** Escondido , CA **Other Locations:** **Job ID #:** ...
  • 3/27/2024 12:00:00 AM

M
Compliance Coordinator Contract
  • Marquee Staffing - CB
  • Vista, CA
  • Job Description Job Description Contract opportunity for a Compliance Coordinator working a hybrid schedule for 6 months...
  • 3/27/2024 12:00:00 AM

A
Claims Adjuster
  • Anchor General Insurance Agency
  • San Diego, CA
  • AUTO CLAIMS EXAMINER/ADJUSTER_ San Diego, CA Residents Anchor General Insurance Company is excited to be recruiting ambi...
  • 3/25/2024 12:00:00 AM

A
Surveillance Investigator
  • Allied Universal® Compliance and Investigations
  • San Diego, CA
  • Overview Allied Universal® Compliance and Investigations, North America's leading expert insurance claim investigations,...
  • 3/15/2024 12:00:00 AM

A
SIU Investigator
  • Allied Universal® Compliance and Investigations
  • San Diego, CA
  • Overview Allied Universal® Compliance and Investigations, North America's leading expert insurance claim investigations,...
  • 3/15/2024 12:00:00 AM

According to SDSU professor emeritus Monte Marshall, San Diego Bay is "the surface expression of a north-south-trending, nested graben". The Rose Canyon and Point Loma fault zones are part of the San Andreas Fault system. About 40 miles (64 km) east of the bay are the Laguna Mountains in the Peninsular Ranges, which are part of the backbone of the American continents. The city lies on approximately 200 deep canyons and hills separating its mesas, creating small pockets of natural open space scattered throughout the city and giving it a hilly geography. Traditionally, San Diegans have built the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$67,033 to $86,422
San Diego, California area prices
were up 2.6% from a year ago

Claims Examiner, Sr. in Riverside, CA
Health Claims Examiners, or Health Information Technicians, enter data electronically to process transactions.
December 14, 2019
Claims Examiner, Sr. in Evansville, IN
If you’re in dire straits, we can advise you on steps to get the OWCP claims examiner to pay attention to your needs, such as contacting the Department of Labor’s district director, or the national director via mail.
February 12, 2020
Claims Examiner, Sr. in Springfield, IL
No, the examiner is only involved in performing the exam and providing the results to the claims processor.
January 13, 2020