Workers Compensation Claims Examiner Jobs
Workers Compensation Claims Examiner jobs are open across insurance carriers, third-party administrators, and self-insured corporations, from entry-level examiner to senior and supervisory roles, with specializations in medical-only claims, lost-time claims, and litigation management. Find a role that fits from the openings below and apply directly.
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Showing 5 of 12+ Workers Compensation 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
ROLE AND RESPONSIBILITIES
Workers Compensation Claims Examiner - Orange, CA
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.
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
- Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
QUALIFICATIONS
Education & Licensing: 5 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: California workers' compensation claims handling experience | SIP certified preferred.
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 $80,000 - $105,000/yr. 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 #hybrid #LI-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
ROLE AND RESPONSIBILITIES
Workers Compensation Claims Examiner - Orange, CA
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.
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
- Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
QUALIFICATIONS
Education & Licensing: 5 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: California workers' compensation claims handling experience | SIP certified preferred.
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 $80,000 - $105,000/yr. 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 #hybrid #LI-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 Workers Compensation Claims Examiner Jobs
Jump back to the full list of openings and apply to any workers compensation claims examiner role that fits.
Find JobsWorkers Compensation Claims Examiner Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- Sedgwick9
- National Union Fire Insurance Company Of Pittsburgh, Pa.2
- AIG1
Top Industries Hiring
- Government & Public Sector9
- Insurance3
What Employers Look For
The qualifications that appear most often in workers compensation claims examiner jobs.
- Two or more years of workers compensation claims handling experience
- State adjuster license in the hiring jurisdiction or ability to obtain one
- Proficiency with claims management systems such as Guidewire, Majesco, or similar platforms
- Knowledge of compensability determinations and applicable state workers compensation statutes
- Experience setting reserves and managing indemnity and medical-only claims
- Associate in Claims (AIC) designation or equivalent professional certification preferred
Tips for Your Workers Compensation Claims Examiner Job Search
Tailor your resume to claim complexity
Hiring managers scan for the types of claims you've handled. Specify whether you managed medical-only, indemnity, or litigated claims, and note average caseload size and jurisdictions covered. Vague summaries get passed over in favor of candidates who show clear scope.
Highlight state adjuster license details
Many postings require a specific state license or the ability to obtain one quickly. List every jurisdiction where you hold an adjuster license, including non-resident licenses. Missing this detail can screen you out before a recruiter reads the rest of your resume.
Target openings by claim handling authority
Job postings for workers compensation claims examiners often specify a reserve-setting authority threshold. Filter for roles where your documented authority level matches, since starting below your experience invites underpay and starting above it risks early rejection.
Apply early to roles that fit
Migrate Mate lists workers compensation claims examiner openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for a technical phone screen first
Most workers compensation claims examiner interviews open with a phone screen focused on jurisdictional knowledge and claims handling procedures, not soft skills. Refresh your understanding of compensability determinations, return-to-work coordination, and subrogation so you answer confidently before the panel stage.
Negotiate using comparable caseload data
When you reach the offer stage, ground your negotiation in the complexity and volume of claims you've managed. Examiners handling high-exposure litigated files or multi-state programs routinely command better compensation than those on simpler portfolios, so document your file mix before the conversation.
Workers Compensation Claims Examiner Jobs: Frequently Asked Questions
Which companies are hiring the most workers compensation claims examiners?
The companies hiring the most workers compensation claims examiners right now include Sedgwick, National Union Fire Insurance Company Of Pittsburgh, Pa., and AIG, with the largest share of openings in California, Kansas, and Georgia, based on current listings on Migrate Mate as of June 2026. Demand is highest at large insurance carriers, third-party administrators, and self-insured employers managing high-volume programs.
How many workers compensation claims examiner jobs are remote?
About 67% of workers compensation claims examiner openings are fully remote or hybrid as of June 2026, reflecting the role's document-heavy, phone-based workflow. Medical-only and indemnity examiner positions tend to be the most remote-friendly, while field case management and litigation-focused roles more often require in-person or regional presence.
How do you become a workers compensation claims examiner?
You typically start by earning a bachelor's degree in business, healthcare administration, or a related field, then apply for an entry-level claims representative role at an insurance carrier or third-party administrator. Most states require you to obtain a licensed adjuster credential, which involves passing a state exam. Building experience across medical-only and indemnity files, then pursuing the Associate in Claims designation, moves you into examiner-level responsibilities.
Can you get hired as a workers compensation claims examiner with little experience?
Yes, entry-level examiner roles exist at carriers and third-party administrators that provide structured training programs. Candidates with a background in medical billing, case management, or paralegal work often transition successfully because they already understand medical terminology, documentation review, and regulatory timelines. Obtaining your state adjuster license before applying gives you a meaningful edge over candidates who have not yet started that process.
What does the workers compensation claims examiner interview process look like?
The process typically begins with a recruiter phone screen covering your claims handling background and adjuster license status. A technical interview with a claims manager follows, focused on compensability decisions, reserve-setting rationale, and jurisdictional knowledge. Some employers include a practical scenario or written exercise. Final rounds often involve a panel with claims operations and HR leaders before an offer is extended.
Where can I find and apply to workers compensation claims examiner jobs?
You can find and apply to workers compensation claims examiner jobs on Migrate Mate, which lists current openings from across the United States. Find the roles that match your experience level, license status, and preferred claim type, then apply directly to each listing that fits.
See All Workers Compensation Claims Examiner Jobs
Jump back to the full list of openings and apply to any workers compensation claims examiner role that fits.
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