Mid Level Medical Claims Examiner Jobs
Mid level medical claims examiner jobs go to professionals ready to own complex claims end to end, guide junior examiners through adjudication decisions, and resolve escalations with minimal oversight. Openings run across Government & Public Sector and Technology & Software, with employers like Sedgwick and TRISTAR hiring at this level now.
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See related jobsBy 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 | Dedicated Client & Capped Caseloads | CT, MA, NJ, VT Jurisdiction Experience | VT & CT LicensingAre 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 examiner 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 OF THE ROLE To analyze Lost-time 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: 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.
Experience: 3 years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: CT, MA, NJ, VT
Licensing: VT & CT
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 ($80K - $90K). 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.
#claimsexaminer #claims #LI-REMOTE
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 | Dedicated Client & Capped Caseloads | CT, MA, NJ, VT Jurisdiction Experience | VT & CT LicensingAre 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 examiner 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 OF THE ROLE To analyze Lost-time 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: 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.
Experience: 3 years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: CT, MA, NJ, VT
Licensing: VT & CT
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 ($80K - $90K). 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.
#claimsexaminer #claims #LI-REMOTE
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.
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Top Industries Hiring
- Government & Public Sector
- Technology & Software
Mid Level Medical Claims Examiner Jobs: Frequently Asked Questions
How do I get a mid level medical claims examiner job?
Position yourself around ownership, not just execution. Highlight claims you resolved independently, any process improvements you contributed to, and experience with specific claim types such as medical, dental, or workers' compensation. Employers at this level want to see that you can handle escalated cases, apply coverage guidelines accurately under pressure, and train or support newer staff without close supervision.
Which companies hire mid level medical claims examiners?
Companies hiring mid level medical claims examiners right now include Sedgwick and TRISTAR, based on current listings on Migrate Mate as of September 2026. Hiring at this level comes primarily from health insurers, managed care organizations, and third-party administrators that need examiners who can handle complex claim reviews with limited oversight.
Are there remote mid level medical claims examiner jobs?
Yes, remote and hybrid options are well established at the mid level. About 100% of mid level medical claims examiner openings are remote or hybrid as of September 2026, reflecting how broadly payers and administrators have adopted distributed claims teams. Fully remote roles typically require demonstrated experience with claims management systems and self-directed production standards.
How do I move up to a mid level medical claims examiner role?
Getting from entry level to mid level means building a record of handling claims with growing independence. Focus on mastering your organization's adjudication guidelines, taking on more complex claim types over time, and finding opportunities to lead a small process or mentor a newer colleague. Employers typically look for consistent accuracy, familiarity with payer-specific systems, and evidence that you have reduced the need for supervisor review on your cases.
Which industries hire the most mid level medical claims examiners?
Mid Level medical claims examiner roles concentrate in Government & Public Sector and Technology & Software, based on current listings on Migrate Mate as of September 2026. These sectors drive hiring at this level because high claim volumes and regulatory complexity require experienced examiners who can adjudicate accurately without extensive oversight on every decision.