Claims Examiner | Riverside, CA or Ontario, CA

Sedgwick; United States; Hybrid; USD 95,000 - 105,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promo growth

Comprehensive benefits

Job summary

Sedgwick is hiring a Claims Examiner in California (Ontario or Riverside) with strong California workers' compensation knowledge. You will analyze complex workers’ compensation claims, adjudicate benefits, and deliver client-focused solutions within a dynamic global company.

The role offers a flexible work arrangement with remote options and opportunities for professional development. Competitive benefits are provided, including medical, dental, vision, and 401(k).

Qualifications

• 3 years of claims management experience or equivalent required.
• High School Diploma or GED required; Bachelor’s degree preferred.
• Professional certification as applicable to line of business preferred.
• 3+ years California workers’ compensation jurisdictional knowledge required; SIP or obtain within 1 year of employment.

Responsibilities

• Analyze and process claims to determine exposure and provide timely resolution.
• Negotiate settlement within designated authority.
• Communicate claim activity with the claimant and client.
• Report claims to the excess carrier and respond to directions professionally and promptly.

Skills

Claims adjudication

Negotiation

Analytical thinking

Client communication

Education

High School Diploma or GED

Bachelor’s degree preferred

Professional certification where applicable

California workers' compensation knowledge licensing

Job description

By joining Sedgwick, you’ll be part of something truly meaningful. It’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’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner | Riverside, CA or Ontario, CA

Are you lookingfor an opportunity to join a global industry leader where you can bring yourbig ideasto help solve problems for some of the world’s best brands?

• Apply your knowledge and experience toadjudicatecomplex workers compensation claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients whorepresentvirtually everyindustry andcomprisesome 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,financialand professional needs.

ARE YOU AN IDEAL CANDIDATE?

Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‑managed intake environment.

OFFICE LOCATION: ONTARIO, CA or RIVERSIDE, CA - remote options available

PRIMARY PURPOSE OF THE ROLE:

To analyzeWorkers Compensationclaims on behalf of our valued clients todeterminebenefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Anayzing and processing claims through well-developed action plans toan appropriateandtimelyresolution by investigating and gathering information todeterminethe exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional andtimelymanner.

QUALIFICATIONS

Education & Licensing: 3 years of claims management experience or equivalent combination of education and experiencerequired.

• High School Diploma or GEDrequired. Bachelor’s degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Licensing / Jurisdiction Knowledge:

3 or more years California workers compensation jurisdictional knowledge required, SIP required or must be obtained within one (1) year of employment

TAKING CARE OF YOU

• Flexibleworkschedule.
• Referralincentiveprogram.
• Career development and promotional growth opportunities.
• Diverse and comprehensive benefits offering including medical, dental vision, 401K on dayone.

WORK ENVIRONMENT REQUIREMENTS

INCLUDE

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

Auditory/Visual:

Hearing, vision and talking

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 $95,000-105,000. 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.

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.

#LI-REMOTE #LI-HYBRID

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’ 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.

Sedgwickis 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.