Workers Compensation Claims Examiner

Sedgwick

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

Posted 10/9/2026full-timeUnited StatesMid-LevelSenior💰 $80,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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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 while managing multiple priorities under pressure.

Highest-signal resume keywords

Claims Management ExperienceWorkers Compensation Claims AnalysisNegotiation of Claim SettlementsCommunication with Claimants and ClientsCalifornia or Nevada License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisClaims ProcessingInvestigation of ClaimsNegotiation SkillsReporting to Excess CarriersProblem SolvingJudgmentComputer Keyboarding

Soft Skills

Clear ThinkingDiscretionAbility to Handle Work-Related StressAbility to Meet Deadlines

Certifications & Qualifications

Professional Certification in Line of Business

Industry Keywords

Workers CompensationClaims AdjudicationClient Service RequirementsAction PlansClaim Exposure

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 claim settlements within designated authority
Communicate claim activity and processing with claimants and clients
Report claims to the excess carrier
Respond professionally and promptly to requests for directions

Requirements

What you’ll need

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
5 years of claims management experience or equivalent combination of education and experience required
Must be licensed in California or Nevada
Ability to analyze and process workers compensation 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 excess carriers and respond to direction requests
Clear and conceptual thinking ability
Excellent judgment, troubleshooting, problem solving, analysis, and discretion
Ability to handle work-related stress and multiple priorities simultaneously
Ability to meet deadlines
Computer keyboarding ability
Hearing, vision, and talking abilities

Benefits

Comp & perks

Flexible work schedule
Referral incentive program
Career development and promotional growth opportunities
Medical, dental, and vision coverage
401(k) and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Remote work flexibility during the current designation, with transition to hybrid work