Claims Examiner
Sedgwick
Posted: 10/19/2026
Claims Recovery Examiner
Health Care Service Corporation
Posted: 10/14/2026
Claims Recovery Examiner
All Care To You
Posted: 10/7/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing and processing complex workers compensation claims, with a strong focus on California jurisdictional knowledge and effective communication with clients and claimants. Proven ability to negotiate settlements and manage caseloads while adhering to industry best practices and service expectations.
Highest-signal resume keywords
Claims Management ExperienceCalifornia Workers Compensation KnowledgeSIP CertificationProblem SolvingClient Communication
About the role
Key responsibilities & impact- Analyze and process complex workers compensation claims using action plans
- Investigate and gather information to determine claim exposure
- Adjudicate claims and determine benefits due
- Resolve claims appropriately and timely within service expectations, industry best practices, and client requirements
- Negotiate claim settlements within designated authority
- Communicate claim activity and processing with claimants and clients
- Report claims to the excess carrier
- Respond professionally and timely to requests for direction
- Build strong client partnerships and manage a reasonable caseload
Requirements
What you’ll need- 3 years of claims management experience or equivalent combination of education and experience required
- High School Diploma or GED required
- 3 or more years of California workers compensation jurisdictional knowledge required
- SIP required or must be obtained within one year of employment
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- 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
- Ability to meet deadlines
- Computer keyboarding ability
- Hearing, vision, and talking
- Qualified applicants must comply with applicable employment laws
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Diverse and comprehensive benefits including medical, dental, vision, 401K on day one
- 401K matching
- Paid time off (PTO)
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Additional voluntary benefits
- Remote options available
- Flexibility and autonomy in daily work, location, and career path
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationClaims InvestigationNegotiationAction Plan DevelopmentComputer Keyboarding
Soft Skills
JudgmentDiscretionStress ManagementMultitaskingDeadline Management
Certifications & Qualifications
SIP CertificationProfessional Certification
Industry Keywords
Workers CompensationClaims ProcessingClient PartnershipsClaim SettlementsExcess Carrier Reporting