Workers Compensation - Claims Standards & Compliance Analyst | Ontario, California

• 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
Hybrid - Ontario, CA
 

PRIMARY PURPOSE OF THE ROLE: To ensure product quality and regulatory compliance while serving as a trusted resource to office operations. This role supports the timely and accurate delivery of benefits and required notices to minimize regulatory penalties, legal exposure, and other adverse outcomes.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Develops, reviews, and analyzes management reports related to claim processes and decisions to ensure legal and regulatory compliance.
• Designs and supports training programs and technical materials to monitor, prevent, and mitigate legal and regulatory claim‑handling exposures, in collaboration with Sedgwick University as needed.
• Participates in roundtable reviews of claim strategy and provides recommendations aligned with legally compliant file‑handling standards.
• Supports and participates in projects related to process, procedural, and compliance updates, including communication of changes to field offices, IT, Legal, and other business units.
• Prepares offices for regulatory audits, serves as a liaison with state auditors, participates in audit debriefs, and assists in developing rebuttal responses when required.
• Educates colleagues, managers, and clients on state regulatory requirements and supports resolution of regulatory and compliance issues.
• Partners with internal quality programs and practice leads to share insights, promote consistent adoption of required forms and procedures, and develop mitigation strategies across business units.
• A reduced caseload can be expected with seemingly complex matters or high visibility claims.
• There is no expectation for the management of others.
• Program compliance initiatives supported for audit compliance, subject to but not limited to benefit timeliness and accuracy, file balancing compliance, training for penalty and interest avoidance strategies, and mitigation of excess costs.

QUALIFICATIONS

Education & Licensing: 5 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 knowledge | SIP Certificate 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.

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 $80,000-$98,000/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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