Medical Claims Examiner Jobs in California
Medical Claims Examiner jobs in California are among the most active in the country, concentrated in managed care organizations, large hospital systems, and workers' compensation carriers that are headquartered or heavily staffed across Los Angeles, Sacramento, and San Diego. Major employers with lasting California footprints include Anthem Blue Cross of California, Kaiser Permanente, and Zenith Insurance Company. The most in-demand specialties are workers' compensation claims, Medicare and Medi-Cal adjudication, and complex medical billing review, with openings at both entry-level and senior examiner tiers. See the openings below and apply to the ones that match your experience.
Find Medical Claims Examiner JobsOverview
Showing 5 of 18+ 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.
See All 18 Medical Claims Examiner Jobs in California
Find roles in California that match your experience and apply in just a few clicks.
Find Medical Claims Examiner JobsMedical Claims Examiner Jobs by City in California
Where California roles are concentrated, by current openings.
Medical Claims Examiner Job Market in California
A snapshot from current California openings, updated as new roles post.
Who's Hiring
- Sedgwick13
- TRISTAR2
- AIMS1
- Gallagher1
- ICW1
Top Industries Hiring
- Government & Public Sector
What California Employers Look For
The qualifications that appear most often in medical claims examiner jobs across California.
- Experience adjudicating workers' compensation claims under California Labor Code guidelines
- Familiarity with Medi-Cal and Medicare coverage rules and California-specific billing codes
- Two or more years of medical claims review or insurance adjudication experience
- Knowledge of ICD-10, CPT, and HCPCS coding systems used in California provider billing
- Strong written communication skills for preparing California-compliant denial and approval letters
- Associate or bachelor's degree in healthcare administration, business, or a related field
Medical Claims Examiner Jobs in California: Frequently Asked Questions
How do you become a medical claims examiner in California?
There is no state-issued license required to work as a medical claims examiner in California, but employers consistently favor candidates with a completed associate or bachelor's degree in healthcare administration, business, or a related field. Workers' compensation examiners benefit from completing the California Self-Insurers' Security Fund coursework or programs offered through the California Workers' Compensation Institute. Professional certifications such as the Certified Professional Coder or Certified Claims Professional designation also strengthen California applications considerably.
Which companies hire medical claims examiners in California?
Employers hiring medical claims examiners in California right now include Sedgwick, TRISTAR, and AIMS, based on current listings on Migrate Mate as of September 2026. California's large managed care market and its distinct workers' compensation system mean demand is especially consistent at health plans, third-party administrators, and self-insured public agencies based across the state.
Which California cities have the most medical claims examiner jobs?
Brea, Orange, and Riverside account for the highest concentration of medical claims examiner openings in California. Los Angeles dominates because it is home to major managed care headquarters and one of the country's largest workers' compensation markets, while Sacramento draws volume from state agency self-insured programs and health plan regional offices, and San Diego benefits from a dense network of hospital systems and military-affiliated insurers.
Are there remote medical claims examiner jobs in California?
Yes, and more than most fields. Medical claims examination is a desk-based analytical role that translates well to remote work because the core tasks involve reviewing digital records and applying coverage rules rather than physical assessment. About 94% of medical claims examiner openings tied to California are remote or hybrid as of September 2026, reflecting how broadly California health plans and third-party administrators have adopted distributed teams. Complex liability and workers' compensation reviews tend to carry the highest share of fully remote postings.
How can I get hired as a medical claims examiner in California with little or no experience?
The most realistic entry path is starting as a claims assistant, billing specialist, or medical coding technician at a California health plan or third-party administrator, then moving into an examiner role once you understand the adjudication workflow. Kaiser Permanente and Anthem Blue Cross of California both run structured associate-level claims programs in California. Completing a Certified Professional Coder credential through AAPC or a healthcare administration certificate from a California community college gives applicants a measurable edge over others with no direct claims background.
Where can I find and apply to medical claims examiner jobs in California?
You can find and apply to medical claims examiner jobs in California on Migrate Mate, which lists current California openings updated in real time. Search for roles that fit your experience level and specialty, whether that is workers' compensation, managed care, or Medicare adjudication, and apply directly to the ones that match. No signup is required to see the openings.
See All 18 Medical Claims Examiner Jobs in California
Find roles in California that match your experience and apply in just a few clicks.
Find Medical Claims Examiner Jobs