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.
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Showing 5 of 29+ 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 ExaminerAre 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.
PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- 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
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Five (5) years of California Workers Compensation 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: California jurisdictional knowledge required ; SIP required or must be obtained within one (1) year of start date.
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
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, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.
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 $80,000 - $100,000 per year . 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 #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1
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 ExaminerAre 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.
PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- 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
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Five (5) years of California Workers Compensation 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: California jurisdictional knowledge required ; SIP required or must be obtained within one (1) year of start date.
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
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, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.
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 $80,000 - $100,000 per year . 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 #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1
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 29 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
- Sedgwick15
- ICW7
- TRISTAR2
- Gallagher2
- TEKsystems1
Top Industries Hiring
- Insurance
- 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, ICW, and TRISTAR, based on current listings on Migrate Mate as of July 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?
Roseville, California, and Pleasanton 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 96% of medical claims examiner openings tied to California are remote or hybrid as of July 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 29 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