Fraud Claims Operations Representative Jobs in Riverside, 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: 7/20/26 ON-SITE Ontario, CA

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.

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 REQUIREMENTSINCLUDE

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 hourly. 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