Medical Claims Examiner Jobs
Medical claims examiner jobs are open across health insurance, managed care, third-party administration, and government programs, from entry-level reviewers to senior and lead examiners, with specializations in medical billing audits, clinical coding review, and fraud investigation. Scan the live roles below and apply to whichever ones fit.
Find Medical Claims Examiner JobsOverview
Showing 5 of 60+ Medical 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 Examiner - CA | On-Site or RemoteAre 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 workers compensation 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? Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‑managed intake environment.
OFFICE LOCATIONS:
RIVERSIDE, CA
ONTARIO, CA
ROSEVILLE, CA
REMOTE OPTIONS MAY BE AVAILABLE
PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
- Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
- Negotiating settlement of claims within designated authority.
- Communicating claim activity and processing with the claimant and the client.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
QUALIFICATIONS
Education & Licensing: 3 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.
Licensing / Jurisdiction Knowledge: 3 or more years California workers compensation 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.
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 $85-95K. 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.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
#LI-REMOTE #LI-HYBRID
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 Examiner - CA | On-Site or RemoteAre 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 workers compensation 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? Seeking a seasoned California Workers Compensation Examiner who values strong client partnerships, enjoys a reasonable caseload, and works within a well‑managed intake environment.
OFFICE LOCATIONS:
RIVERSIDE, CA
ONTARIO, CA
ROSEVILLE, CA
REMOTE OPTIONS MAY BE AVAILABLE
PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
- Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
- Negotiating settlement of claims within designated authority.
- Communicating claim activity and processing with the claimant and the client.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
QUALIFICATIONS
Education & Licensing: 3 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.
Licensing / Jurisdiction Knowledge: 3 or more years California workers compensation 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.
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 $85-95K. 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.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
#LI-REMOTE #LI-HYBRID
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.
Medical Claims Examiner Jobs by Experience Level
See All 60 Medical Claims Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
Find Medical Claims Examiner JobsMedical Claims Examiner Job Market
Who's Hiring
- Sedgwick25
- TRISTAR7
- TEEMA2
- ICW2
- AIG Claims2
Top Industries Hiring
- Government & Public Sector
- Insurance
- Technology & Software
What Employers Look For
The qualifications that appear most often in medical claims examiner jobs.
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Experience processing medical, dental, or pharmacy claims end to end
- Familiarity with claims adjudication platforms such as TriZetto or Facets
- Understanding of explanation of benefits documents and coordination of benefits rules
- High school diploma or associate degree, with a bachelor preferred at senior levels
- Professional certification such as CPC, CCS, or CHC from an accredited body
Tips for Your Medical Claims Examiner Job Search
Tailor your resume to claim types
Highlight the specific claim types you've handled, such as facility, professional, dental, or pharmacy claims. Recruiters scan for these terms fast, so list them in your skills section and echo the language in each job posting you target.
List coding credentials prominently up top
Certifications like CPC, CCS, or CHC carry real weight in this field. Place them immediately after your name in the resume header so hiring managers see them before reading a single bullet. Buried credentials get missed.
Apply early to roles that fit
Migrate Mate lists medical claims examiner openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Filter openings by adjudication software
Job postings often name the claims processing platform used, such as TriZetto, Facets, or QNXT. When you have hands-on experience with the listed system, say so explicitly in your application. That match can move you past automated screening quickly.
Prepare concrete examples of overpayment recovery
Interviewers at insurers and TPAs routinely ask for a specific case where you caught a billing error or duplicate claim. Have one ready with a real outcome, whether that was a dollar amount recovered or a process you flagged, so your answer has substance.
Negotiate using productivity benchmarks
Claims examiner offers often tie compensation to throughput expectations. Before your final conversation, know what daily or weekly volume the role requires, then use that context to discuss whether the offer reflects the complexity of the claim mix you'll handle.
Medical Claims Examiner Jobs: Frequently Asked Questions
Which companies are hiring the most medical claims examiners?
The companies hiring the most medical claims examiners right now include Sedgwick, TRISTAR, and TEEMA, with the largest share of openings in California, Texas, and Florida, based on current listings on Migrate Mate as of September 2026. Health insurers, third-party administrators, and government contractors consistently represent the largest share of active postings.
How many medical claims examiner jobs are remote?
About 87% of medical claims examiner openings are fully remote or hybrid as of September 2026, reflecting how much of the work involves reviewing digital records and adjudicating claims through web-based platforms. Roles focused on routine processing and auditing tend to be the most remote-eligible, while positions that require in-person collaboration with clinical staff are more likely to stay on-site.
How do you become a medical claims examiner?
Start by building a foundation in medical billing and coding through a certificate program or associate degree in health information management. Earning a credential such as a CPC or CCS validates your coding knowledge to employers. Entry-level positions at insurers or TPAs give you hands-on adjudication experience, and from there you can move into senior examiner or auditing roles as your claim-type expertise deepens.
Can you get hired as a medical claims examiner with little experience?
Yes, many employers hire entry-level examiners who have completed a medical billing and coding program even without prior claims work. Demonstrating familiarity with ICD-10 and CPT codes, showing attention to detail in your resume and cover letter, and targeting smaller regional insurers or outsourcing firms that train in-house all improve your chances when your direct experience is limited.
What does the medical claims examiner interview process look like?
Most hiring processes include an initial screening call focused on your claims background and system experience, followed by a technical or skills assessment that may involve reviewing a sample claim for errors. A panel or second interview typically covers scenario-based questions about disputed claims, coordination of benefits situations, and your process for catching billing discrepancies before adjudication is finalized.
Where can I find and apply to medical claims examiner jobs?
You can find and apply to medical claims examiner jobs on Migrate Mate, which lists current openings from employers across the United States. Search the available roles, identify the ones that match your claim-type experience and certifications, and apply directly to each listing that fits your background and location preferences.
See All 60 Medical Claims Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
Find Medical Claims Examiner Jobs