Workers Compensation Claims Examiner

Sedgwick

. Analyze and process workers compensation claims through action plans toward appropriate and timely resolution .

Posted 10/14/2026full-timeOrange • California • United StatesMid-LevelSenior💰 $85,000 - $105,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing workers compensation claims, including negotiation, analysis, and client communication, while adhering to industry best practices and service expectations. Possesses strong problem-solving abilities and the capacity to manage multiple priorities effectively.

Highest-signal resume keywords

Claims Management ExperienceCalifornia Workers Compensation KnowledgeNegotiation SkillsSIP CertificationClient Relationship Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisClaims ProcessingNegotiationAdjudicationProblem SolvingJudgmentComputer Keyboarding

Soft Skills

Clear ThinkingDiscretionAbility to Handle StressAbility to Meet Deadlines

Certifications & Qualifications

SIP CertificationProfessional Certification

Industry Keywords

Workers CompensationClaim ExposureClient Service RequirementsIntake EnvironmentExcess Carrier Reporting

About the role

Key responsibilities & impact

Analyze and process workers compensation claims through action plans toward appropriate and timely resolution
Investigate and gather information to determine claim exposure
Negotiate claim settlements within designated authority
Communicate claim activity and processing with claimants and clients
Report claims to the excess carrier and respond to requests for directions
Determine benefits due while ensuring ongoing adjudication within service expectations, industry best practices, and client service requirements
Build and maintain strong client partnerships within a well-managed intake environment

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
Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
3 or more years of California workers compensation jurisdictional knowledge required
SIP required or must be obtained within one year of employment
Ability to think clearly and conceptually
Excellent judgment, troubleshooting, problem solving, analysis, and discretion
Ability to handle work-related stress and multiple priorities simultaneously
Ability to meet deadlines
Computer keyboarding
Hearing, vision, and talking

Benefits

Comp & perks

Flexibility and autonomy in daily work, location, and career path
Professional development opportunities
Flexible work schedule
Referral incentive program
Career development and promotional growth opportunities
Medical, dental, and vision benefits
401(k) and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits