TRISTAR Insurance Group

Supervisor

• Manage and direct activity of claims unit ensuring high-quality results and compliance with state laws
• Supervise examiners and clerical staff
• Address scheduled claims issues, such as reviews, delays, and denials
• Approve reserve changes, awards, and payments within authority
• Monitor compliance with policies and laws through file reviews
• Coordinate and lead training sessions on updated laws and procedures
• Ensure caseload staffing requirements are met
• Respond to claimant and vendor concerns

Property & Casualty Claims Supervisor

• The Supervisor is accountable for overseeing the performance of their assigned team.
• Represents the company in a professional manner to both internal and external customers and clients.
• Assures performance standards of the team through continued training and coaching.
• Monitors staff work assignments and makes appropriate adjustments based on staffing levels.
• Responsible for completing annual reviews for direct reports with Manager input.

Supervisor, Case Management

Manager

• Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care.
• Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan.
• Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner.
• Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services.
• Assessment of medical records for appropriateness of treatment and level of care being provided.
• Referral to the Medical Director if appropriate within the established timeframes.
• Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians.
• Maintains contact and communicates updated activity with all parties involved with the case.
• Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes.
• Negotiate treatment plan with treating physician.

Medical Case Manager – Telephonic Case Management

• Manage and coordinate administrative tasks
• Support the team with clerical duties
• Assist in scheduling meetings and organizing events
• Maintain records and files

Vendor Manager

Claims Specialist

• Manages all aspects of indemnity claims handling from inception to conclusion
• Initiates and conducts investigation in a timely manner
• Determines compensability of claims and administers benefits
• Develops and manages claims through well-developed action plans
• Manages medical treatment and medical billing
• Calculates and pays benefits due and approves all claim payments
• Manages claim recoveries of all types
• Communicates with clients, claimants, providers, and vendors regarding claims issues
• Computes and sets reserves within Company guidelines
• Settles and/or finalizes all claims

Workers' Compensation Claims Examiner III

• Directly supervise examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Reviews and approves reserve changes, awards, and payments within Company and Client guidelines.
• Performs file reviews to monitor compliance with policies and laws.
• Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates.
• Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.
• Coordinates and leads training sessions for staff on updated laws, policies, and procedures.
• Ensures daily caseload staffing requirements are met.
• Responds to claimant and vendor concerns and issues as needed.
• Ensures client service instructions are adhered to.
• Analyzes monthly client reports.
• Facilitates internal and external audits.
• Attend client file-staffing meetings in person or telephonically.
• Other duties as assigned.

Worker Compensation Claims Supervisor

General

• Set up and administer Leave of Absence, Voluntary Disability, Paid Family Leave, Short Term Disability and Long-Term Disability Claims in accordance with TRISTAR ICS protocols
• Can operate efficiently with minimum need for active supervision
• Exercises good judgment about when to ask for supervisory intervention or otherwise surface issues
• Can back up/fill in for the supervisor on many administrative tasks
• Acts as a mentor/trainer for other staff and is a technical resource
• Manages, tracks, and determines eligibility for all aspects of job protected leaves including federal, statutory, employer sponsored leaves (i.e. FMLA, CFRA, PDL, PLOA)
• Acts as a resource to clients and staff regarding the requirements and regulations of the above-mentioned leaves with company benefits and internal leave policies
• Follow established procedures and policies to administer disability/PFL claims in a timely and efficient manner
• Coordinate coverage and administration of insured programs with the appropriate carrier
• Establish and maintains rapport with clients and their employees to ensure customer service goals are met
• Maintain and administer appropriate check cycle payments and procedures
• Coordinate return to work efforts with claimant, provider, and client
• Answer all telephone claim calls from claimants, clients and carriers within 24 hours
• Provide highest quality of customer service
• Follow attendance policy: consistency in work schedule and punctuality
• All other duties as assigned

Senior Integrated Absence Specialist

• Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability of claims and administers benefits based upon state law and TRISTAR Best Practices for claim handling.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel and participates in litigated matters.
• Communicates with claimants, attorneys, providers, and vendors regarding claims issues.
• Works in an organized and proactive manner.
• Computes and sets reserves within Company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains a diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
• Conducts file reviews as scheduled by the client and management.
• Identifies and reviews claims for the Apportionment assignment.
• Identifies and investigates subrogation potential and pursues recovery.
• Identifies claim standard criteria for excess reporting and reimbursement.
• Assists with State Audit and reporting responses.
• Mentors less experienced Examiners.
• Other duties as assigned, including claims management of other jurisdictional workers’ comp claims. Adheres to all TRISTAR company policies and procedures.

Claims Examiner III

• Provides oversight and leadership to a team of claims adjusters.
• Oversee claims from initial review through final resolution.
• Ensure claims are investigated, evaluated, and resolved efficiently.
• Maintain an ongoing diary.
• Provide outstanding service to the client.

Property and Casualty Claims Supervisor

Operator

• Answer and assist with all incoming calls, including first notice, and route them.
• Manage a high-volume, multi-line telephone system effectively.
• Set up and enter new liability, subrogation, and first notice of loss reports.
• Monitor dedicated client email inboxes for new first notice loss reports.
• Maintain confidentiality and comply with HIPAA and PHI regulations.
• Demonstrate proficiency in transcription and data entry.

Telephonic Intake Operator

• Serve as the initial point of contact for callers reporting new Workers’ Compensation, Liability, and Subrogation claims.
• Answer and assist with all incoming calls including first notice.
• Manage a high-volume, multi-line telephone system effectively.
• Set up and enter new liability, subrogation, and first notice of loss reports.
• Accurately document each call and its outcome in a clear, concise, and timely manner.
• Maintain confidentiality and comply with HIPAA and PHI regulations.

Central Services Telephonic Intake Operator

• Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines.
• 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.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

Workers Compensation Claims Examiner III

• Answer and assist with all incoming calls, including first notice, and route them to the appropriate person or department.
• Manage a high-volume, multi-line telephone system effectively.
• Set up and enter new liability, subrogation, and first notice of loss reports in the claims/notice reporting systems or portals.
• Accurately document each call and its outcome in a clear, concise, and timely manner.
• Monitor dedicated client email inboxes for new first notice loss reports.
• Monitor phone lines and hold times, report excessive hold times to the supervisor for adjustment.
• Perform a variety of clerical duties as assigned.
• Maintain confidentiality and comply with HIPAA and PHI regulations.
• Use communication tools such as instant messaging, email, and Zoom to stay connected with team members and supervisors.

• Effectively manages a caseload of 150 or fewer workers’ compensation files, including complex claims.
• Initiates and investigates promptly.
• Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Settles and finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work 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.
• Conducts file reviews independently.

• Manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines
• Effectively manages a caseload of 150 workers’ compensation files
• Initiates and conducts investigations in a timely manner
• Determines compensability of claims and administers benefits
• Manages medical treatment and billing
• Refers cases to outside defense counsel and directs as appropriate
• Communicates with claimants, providers and vendors regarding claims issues
• Computes and sets reserves within Company guidelines
• Settles and/or finalizes all claims
• Maintains diary system for case review and documents file status
• Communicates appropriate information promptly to the client

Property & Casualty Claims Supervisor

Supervisor, Case Management

Medical Case Manager – Telephonic Case Management

Vendor Manager

Workers' Compensation Claims Examiner III

Worker Compensation Claims Supervisor

Senior Integrated Absence Specialist

Claims Examiner III

Property and Casualty Claims Supervisor

Telephonic Intake Operator

Central Services Telephonic Intake Operator

Workers Compensation Claims Examiner III

Telephonic Intake Operator

Workers Compensation Claims Examiner III

Worker Compensation Claims Examiner III