Workers Compensation Claims Examiner

Sedgwick

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

Posted 9/22/2026full-timeBrea • California • United StatesMid-LevelSenior💰 $85,000 - $105,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in analyzing and processing workers compensation claims, ensuring timely resolution and adherence to industry best practices. Proficient in negotiating settlements and communicating effectively with claimants and clients.

Highest-signal resume keywords

Claims Management ExperienceCalifornia Workers Compensation Jurisdictional KnowledgeSIP CertificationProblem SolvingNegotiation Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AnalysisClaims ProcessingSettlement NegotiationAdjudicationComputer Keyboarding

Soft Skills

Clear ThinkingExcellent JudgmentTroubleshootingDiscretionAbility to Handle Stress

Certifications & Qualifications

SIP CertificationProfessional Certification

Industry Keywords

Workers Compensation ClaimsClaim ExposureClient Service RequirementsService ExpectationsIndustry Best Practices

About the role

Key responsibilities & impact

Analyze and process workers compensation claims through well-developed action plans toward appropriate and timely resolution
Investigate 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 and respond to requests for direction professionally and promptly
Analyze workers compensation claims to determine benefits due
Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements

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 (1) 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
Hearing, vision and talking

Benefits

Comp & perks

Flexible work schedule
Referral incentive program
Career development and promotional growth opportunities
Diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one
401k and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Remote options available
Reasonable accommodations where applicable and appropriate