Workers Compensation Claims Examiner III (Remote)

POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 150-180 workers’ compensation files, including very complex claims.*
• Initiates and conducts investigations in a timely manner.*
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Communicate with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II with changes authorized up to $1,000,000.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.*
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*
• Involves TRISTAR loss control staff when appropriate.
• Adheres to all Company policies and procedures.*
• Other duties as assigned.

* Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire

Qualifications

QUALIFICATIONS REQUIRED:

Education/Experience: High School Diploma or GED required. Bachelor’s degree in a related field (preferred); five (5) or more years of related experience; or equivalent combination of education and experience.

Knowledge, Skills, and Abilities:

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

• Texas Workers Compensation License

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision, Disability & Life Insurance
• 401(k) Plan
• Paid time off
• Paid holidays
• Referral bonus