Remote Claims Examiner — Workers' Comp Specialist

Sedgwick; Riverside (CA); Hybrid; USD 95,000 - 105,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Career development

Benefits package

Job summary

Sedgwick is seeking a Claims Examiner in Riverside, CA or Ontario, CA to analyze workers' compensation claims for our valued clients. You will adjudicate claims, determine benefits, and ensure service expectations are met within a well‑managed intake environment.

Ideal candidates bring 3+ years California WC jurisdictional knowledge and at least a High School diploma; a Bachelor's degree or certifications are preferred.

Qualifications

• 3 years of claims management experience or equivalent combination of education and experience 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 required or must be obtained within one year of employment.

Responsibilities

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the 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 and timely manner.

Skills

Claims management experience

Education

High School Diploma or GED

Bachelor's degree

Professional certification

Job description

Sedgwick is seeking a Claims Examiner in Riverside, CA or Ontario, CA to analyze workers' compensation claims for our valued clients. You will adjudicate claims, determine benefits, and ensure service expectations are met within a well‑managed intake environment.

Ideal candidates bring 3+ years California WC jurisdictional knowledge and at least a High School diploma; a Bachelor's degree or certifications are preferred.