Workers Compensation Claims Examiner | Riverside, CA
About The Position
The Workers Compensation Claims Examiner analyzes workers compensation claims on behalf of clients to determine benefits due. The role ensures ongoing claim adjudication within service expectations, industry best practices, and specific client service requirements. The ideal candidate is a seasoned California Workers Compensation Examiner who values strong client partnerships, a reasonable caseload, and a well-managed intake environment. The position is based in Riverside, California, with a hybrid work arrangement. The role involves investigating claims, determining exposure, developing action plans, and processing claims toward appropriate and timely resolution. The examiner also negotiates settlements within designated authority, communicates claim activity with claimants and clients, and reports claims to excess carriers while responding to their requests for direction. Sedgwick describes a caring culture, work-life balance, flexibility and autonomy, professional development, and career growth opportunities. The listed starting pay range for this jurisdiction is $85,000–$105,000. Benefits include medical, dental and vision coverage, a 401(k) with matching, paid time off, disability and life insurance, employee assistance, flexible spending or health savings accounts, and additional voluntary benefits.
Requirements
- At least 3 years of claims management experience, or an equivalent combination of education and experience.
- High school diploma or GED.
- At least 3 years of California workers compensation jurisdictional knowledge.
- SIP certification is required or must be obtained within one year of employment.
- Ability to exercise judgment, troubleshoot, solve problems, analyze information, and use discretion.
- Ability to handle work-related stress, manage multiple priorities, and meet deadlines.
- Computer keyboarding ability.
- Hearing, vision, and talking abilities.
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 through action plans, investigating and gathering information to determine claim exposure and reach an appropriate, timely resolution.
- 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 direction professionally and promptly.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Medical, dental, and vision coverage.
- 401(k) with matching, available on day one.
- Paid time off.
- Disability and life insurance.
- Employee assistance program.
- Flexible spending account or health savings account.
- Additional voluntary benefits.
- Professional development opportunities.
- Work-life balance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
