Workers’ Compensation Claims Examiner

Bluegrass Stream LLC; Temescal Valley (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Bluegrass Stream LLC is seeking a Claims Examiner for Workers’ Compensation to assess medical records, accident reports, and claim details to determine coverage and compensability. You will document findings and support timely resolutions.

You will collaborate with employers, injured workers, medical providers, attorneys, and internal teams to settle claims fairly and in compliance with regulations.

Qualifications

• Strong analytical skills to assess medical and incident documentation.
• Knowledge of workers’ compensation claim processes, regulations, and negotiation principles.
• Excellent communication and relationship management across multiple stakeholders.
• Detail-oriented decision-making and sound claims handling judgment.

Responsibilities

• Analyze claim information to support coverage and compensability decisions.
• Set and adjust claim reserves based on investigation findings and guidelines.
• Negotiate settlements in compliance with regulations and internal standards.
• Coordinate with employers, injured workers, medical providers, attorneys, and internal teams.
• Ensure timely, fair, and well-documented claim resolutions.

Skills

Analytical thinking

Regulatory knowledge

Negotiation

Communication

Detail-oriented

Ethical judgment

Job description

Claims Examiner, Workers’ Compensation

Evaluate, investigate, and resolve workers’ compensation claims for a diverse client base. Review medical records and accident reports to determine coverage and compensability, assess claim details, and maintain accurate case documentation.

Key Responsibilities

• Analyze claim information to support coverage and compensability decisions.
• Set and adjust claim reserves based on investigation findings and guidelines.
• Negotiate settlements in compliance with regulations and internal standards.
• Coordinate with employers, injured workers, medical providers, attorneys, and internal teams.
• Ensure timely, fair, and well-documented claim resolutions.

Qualifications & Skills

• Strong analytical skills to assess medical and incident documentation.
• Knowledge of workers’ compensation claim processes, regulations, and negotiation principles.
• Excellent communication and relationship management across multiple stakeholders.
• Detail-oriented decision-making and sound claims handling judgment.
• Commitment to ethical, client-focused service.