Claims Representative

Claims Representative (IAP) - Workers Compensation Training Program (On‑Site Orange, CA) Primary Purpose of the Role: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4‑week concept‑based learning and professional training program, followed by a dedicated onboarding experience before entering the on‑the‑job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you’ll have the opportunity to grow and advance within the industry. Next Class Date: 7/20/26 at 333 City Blvd. West Suite 1500 Orange, CA 92868 Are you an Ideal Candidate? Strong Communicators Empathetic Multi‑Taskers Accountable Structured Thinkers Ambitious Agile Learners Team Collaborators Essential Responsibilities Include Attendance and completion of designated claims professional training program. Adjusting various levels of workers' compensation claims under close supervision, which includes: Processing and responding to incoming mail, emails and other claim related documents according to status of the claim. Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email. Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators. Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements. Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations. Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim‑related action items, ensuring state compliance. Participating in virtual and/or in‑person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings. Qualifications Education Requirement – High School Diploma or GED. Basic Preference: Bachelor’s degree and 2 years of customer service experience and/or combination of education and experience. Work Environment Requirements 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 $27.69. 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. 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. #J-18808-Ljbffr