Entry Level Insurance Fraud Investigator Jobs in Riverside, CA

Ontario, CA

Full time

R76212

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.

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Claims Representative (IAP) - Workers Compensation Training Program | Ontario, CA

Are you looking for an impactful job that offers an opportunity to develop a professional career?

• A stable and consistent work environment in an office setting.

• A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world's most reputable brands.

• Career development and promotional growth opportunities through increasing responsibilities.

• A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision & 401k.

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: 10/12/26

Location: Ontario, CA - Onsite

ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:

• Strong Communicators

• Empathetic

• Multi-Taskers

• Accountable

• Structured Thinkers

• Ambitious

• Agile Learners

• Team Collaborators

ESSENTIAL RESPONSIBLITIES 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.

• Bachelor's degree preferred and 2 years of customer service experience and/or combination of education and experience.

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 $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. #claims #entrylevel #onsite

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com