Claims Examiner Jobs
Claims Examiner jobs are open across health insurance, workers' compensation, and property and casualty insurance, with specializations in liability, medical billing review, and fraud investigation, at levels from entry-level to senior examiner and supervisor. Find a role that fits below and apply directly.
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Showing 5 of 88+ Claims Examiner jobs
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Workers Compensation Claims ExaminerWorkers Compensation - Claims Examiner
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
- Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
- Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATION: Brea, California
PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- Manages subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Three (3) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.
TAKING CARE OF YOU
- 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.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: 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; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $73,000 - 85,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
#Claims #ClaimsAdjuster #Hybrid #Remote
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Workers Compensation Claims ExaminerWorkers Compensation - Claims Examiner
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
- Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
- Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATION: Brea, California
PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- Manages subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Three (3) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.
TAKING CARE OF YOU
- 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.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: 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; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $73,000 - 85,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
#Claims #ClaimsAdjuster #Hybrid #Remote
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
See All 88 Claims Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
Find Claims Examiner JobsClaims Examiner Job Market
Who's Hiring
- Sedgwick53
- TRISTAR7
- AIG Claims4
- ICW3
- WPS Health Solutions2
Top Industries Hiring
- Government & Public Sector
- Insurance
- Technology & Software
What Employers Look For
The qualifications that appear most often in claims examiner jobs.
- Two or more years of experience examining and resolving insurance claims independently
- Active property and casualty or workers' compensation adjuster license in the hiring state
- Proficiency with claims management systems such as Guidewire, Duck Creek, or similar platforms
- Working knowledge of coverage interpretation, policy language, and applicable state regulations
- Bachelor's degree in business, finance, or a related field, or equivalent work experience
- Professional designation such as AIC, CPCU, or ARM preferred for senior-level positions
Tips for Your Claims Examiner Job Search
Tailor your resume to claim type
Hiring managers read for the specific line of business, so a resume built around workers' comp claims reads differently than one built around medical or property claims. Lead with the claim types you've handled and the systems you used to manage them.
List your adjuster license by state
Many postings require an active adjuster license, and recruiters filter by state. List every state where you hold a license in a dedicated credentials section, and note whether each is a designated home state license or a reciprocal one.
Apply early to roles that fit
Migrate Mate lists claims examiner openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Show reserve accuracy in your resume
Examiners are measured on reserve adequacy, so quantify your performance if you can. Describing the volume and complexity of files you managed signals competence faster than a list of duties ever will.
Prepare for coverage interpretation questions
Interviewers test whether you can read a policy and apply it to a disputed claim scenario. Practice walking through a denial decision out loud, referencing the specific policy language and the state regulation that supports your position.
Follow up after interviews with claim context
A brief follow-up email that references a specific claim scenario you discussed signals genuine interest and analytical recall. Avoid generic thank-you notes and connect your message back to a problem the team mentioned during the conversation.
Claims Examiner Jobs: Frequently Asked Questions
Which companies are hiring the most claims examiners?
Sedgwick, TRISTAR, and AIG Claims are hiring the most claims examiners right now, with openings concentrated in California, Alaska, and Texas, based on current listings on Migrate Mate as of November 2026. Volume tends to track property catastrophe seasons and open enrollment periods in health insurance.
How many claims examiner jobs are remote?
About 88% of claims examiner openings are fully remote or hybrid as of November 2026, with the highest remote share in medical claims review and health insurance examiner roles. Workers' compensation and complex liability positions are more likely to require in-office presence because of field investigation coordination and state regulatory reporting requirements.
How do you become a claims examiner?
Start with a degree in business, finance, or a related field, or build toward one while working in a claims support or assistant role. Obtain a state adjuster license, which requires passing a written exam and completing continuing education hours in most states. Build experience across a specific line of business, then pursue a professional designation like the AIC to advance into senior examiner roles.
Can you get hired as a claims examiner with no experience?
Some carriers hire entry-level examiners directly into training programs, particularly for high-volume lines like auto or health claims where the work is more standardized. A background in customer service, healthcare billing, paralegal work, or financial services transfers well and addresses the analytical and communication skills employers look for. Getting your adjuster license before applying strengthens an entry-level application considerably.
What does the claims examiner interview process look like?
Most processes include an initial screening call, a structured competency interview focused on coverage analysis and decision-making under ambiguity, and a scenario round where you work through a claim file or coverage dispute out loud. Some employers add a written exercise involving policy interpretation. Senior roles often include a panel interview with underwriting or legal stakeholders who assess how you communicate claim decisions.
Where can I find and apply to claims examiner jobs?
You can find and apply to claims examiner jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your line of business, experience level, and preferred location, then apply directly to each listing that fits.
See All 88 Claims Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
Find Claims Examiner Jobs