Claims Examiner I, Workers Compensation

Sedgwick

. Analyze workers compensation claims on behalf of clients to determine benefits due .

Posted 10/22/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $60,234 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing and processing workers compensation claims, negotiating settlements, and communicating effectively with clients and claimants. Possesses strong analytical skills and knowledge of California jurisdiction requirements.

Highest-signal resume keywords

Claims Management ExperienceWorkers Compensation Claims ExaminationCalifornia Jurisdiction KnowledgeNegotiation of Claim SettlementsCommunication with Claimants and Clients

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisClaims ProcessingInvestigation of ClaimsSettlement NegotiationReporting to Excess Carrier

Soft Skills

Excellent JudgementClear ThinkingDiscretionAbility to Meet Deadlines

Tools & Technologies

Computer Keyboarding

Certifications & Qualifications

Professional Certification in Line of Business

Industry Keywords

Workers CompensationClaims AdjudicationClient Service RequirementsAction PlansCustomer-Facing Solutions

About the role

Key responsibilities & impact

Analyze workers compensation claims on behalf of clients to determine benefits due
Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
Analyze and process claims through action plans to timely resolution
Investigate claims and gather information to determine claim exposure
Negotiate settlement of claims within designated authority
Communicate claim activity and processing with claimants and clients
Report claims to the excess carrier
Respond to requests for directions professionally and promptly
Leverage Sedgwick's global network of experts to learn and share insights
Deliver customer-facing solutions to clients across industries

Requirements

What you’ll need

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
Workers compensation claims examination knowledge and experience
California jurisdiction knowledge/licensing
Ability to analyze and process claims
Ability to investigate claims and gather information to determine exposure
Ability to negotiate claim settlements within designated authority
Ability to communicate claim activity and processing with claimants and clients
Ability to report claims to the excess carrier and respond to requests for directions
Computer keyboarding
Hearing, vision, and talking abilities
Clear and conceptual thinking ability
Excellent judgement and discretion
Ability to meet deadlines

Benefits

Comp & perks

Flexible work schedule
Referral incentive program
Opportunity to work in an agile environment
Career development and promotional growth opportunities
Medical, dental, and vision insurance
401(k) and matching
Paid time off (PTO)
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Flexible and autonomous daily work, location, and career path
Professional development opportunities