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Claims Examiner III
TRISTAR Insurance GroupClaims Examiner III managing all aspects of indemnity claims for TRISTAR. Requires bachelor’s degree and 1-5 years experience in insurance claims.
About the role
Key responsibilities & impact- Under general supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
- Effectively manages a caseload of 150 to 180 workers’ compensation files, including complex claims.
- Initiates and conducts claims investigation 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.
- Refers cases to outside defense counsel as appropriate. Monitors legal aspects.
- Communicates with claimants, providers, and vendors regarding claims issues.
- Computes and sets reserves within Company guidelines. Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I.
- Settles and/or finalizes all claims and obtains authority as designated.
- Maintains a diary system for case review and document 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.
Requirements
What you’ll need- Bachelor’s degree in related field (preferred); and one (1) to five (5) years related experience; or equivalent combination of education and experience.
- Technical knowledge of statutory regulations and medical terminology.
- Analytical skills.
- Excellent written and verbal communication skills, including 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).
- Certification and/or license as required by State regulation.
Benefits
Comp & perks- Medical, Dental, Vision Insurance.
- Life and Disability Insurance.
- 401(k) Plan
- Paid Holidays
- Paid Time Off.
- Referral bonus.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills & Tools
Claims HandlingCompensability DeterminationMedical Billing ManagementReserve ComputationCase Review Management
Soft Skills
Interpersonal SkillsIndependent ManagementProblem-Solving
Certifications
State Certification or License