Teams at Sedgwick

Examines and adjudicates complex California workers’ compensation claims, including investigation, benefit calculations, reserves, payments, litigation, settlements, recoveries, subrogation, and cost containment. The role prepares statutory filings, coordinates vendors, reports claims to excess carriers, maintains accurate claim documentation and coding, and communicates with claimants, clients, and internal stakeholders while managing claims through timely resolution.

Analyzes and administers FMLA, state, military, company-specific, paid, and unpaid leave claims. Determines eligibility, benefit payments, and adjustments according to client plans and applicable regulations. Establishes and tracks claims, reviews documentation, communicates decisions with claimants and clients, maintains professional relationships, and meets quality and service standards.

Provides administrative and customer service support to claims staff by setting up claims, entering notes, processing payments, managing correspondence, preparing reports and forms, scheduling medical appointments, handling telephone calls, and completing filing, faxing, photocopying, and other office tasks.