Workers Compensation Claims Examiner

Sedgwick

Workers Compensation Claims Examiner analyzing complex claims for Sedgwick's clients. Managing claims resolutions and negotiating settlements within designated authority in a hybrid role.

Posted 6/19/2026full-timeOrange • California • 🇺🇸 United StatesMid-LevelSenior💰 $80,000 - $105,000 per yearWebsite

About the role

Key responsibilities & impact

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim;
Manages claims through well-developed action plans to an appropriate and timely resolution.
Negotiates settlement of claims within designated authority.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
Prepares necessary state filings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.

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.
California workers' compensation claims handling experience | SIP certified preferred

Benefits

Comp & perks

Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims managementworkers' compensation claimsnegotiationreserve calculationclaims settlementstate filingslitigation managementcost containment techniquessubrogationclaims coding

Soft Skills

communicationprofessional relationshipsproblem-solvingtimelinessorganization

Certifications

SIP certification