Claims Examiner | Riverside, CA or Ontario, CA

Sedgwick•Riverside, CA

3d•Remote

About The Position

Sedgwick is seeking a seasoned California Workers Compensation Examiner to analyze claims on behalf of clients, determine benefits due, and ensure ongoing adjudication meets service expectations, industry best practices, and client requirements. The role is based in Ontario or Riverside, California, with remote options available. The ideal candidate values strong client partnerships, a reasonable caseload, and a well-managed intake environment. The examiner investigates claims, develops action plans, and works toward timely resolutions. The role also involves negotiating settlements within delegated authority, communicating claim activity with claimants and clients, and reporting claims to excess carriers while responding to their requests for direction. The position offers a flexible work schedule, career development and promotional opportunities, and a comprehensive benefits package.

Requirements

Three years of claims management experience, or an equivalent combination of education and experience.
High school diploma or GED.
At least three years of California workers compensation jurisdictional knowledge.
SIP required or must be obtained within one year of employment.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification applicable to the line of business.

Responsibilities

Analyze and process claims using well-developed action plans, investigating and gathering information to determine claim exposure and reach appropriate, timely resolutions.
Negotiate claim settlements within designated authority.
Communicate claim activity and processing with claimants and clients.
Report claims to excess carriers and respond to requests for direction professionally and in a timely manner.