TRISTAR Insurance Group

Claims Specialist

• Responsible for the prompt review of policy information to determine coverage for loss/damage/injury.
• Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation.
• Frequent contact and interaction with involved parties including claimants and their legal representatives.
• Recommendations regarding loss exposure and associated reserve and settlement strategy communicated to the client.
• Review and interpret coverage, process, and conclude assigned Personal Injury Protection (PIP) claims including investigation and evaluation of Auto and/or General Liability Casualty Claims in the jurisdiction of NY and NJ.
• Respond to PIP Arbitration Proceedings.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of coverage, liability, and damages.
• Determine if subrogation and/or risk transfer exists and initiate recovery efforts in the direction of the client.
• Document all correspondence, reports, discussions, and decisions in the claim file record.
• Provide outstanding service to the client.

Commercial Auto No Fault, PIP Claims Examiner III – Temp

• 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.

Claims Examiner III

• Responsible for the prompt review of policy information to determine coverage for loss/damage/injury
• Conduct an efficient claim examination and investigation leading to the final resolution of liability claims
• Frequent contact and interaction with involved parties including claimants and their legal representatives
• Maintain an ongoing diary and prepare Loss Reports providing thorough analysis of coverage, liability, and damages.

Commercial Auto, BI & GL Claims Examiner III

• Effectively manages a caseload of 150 or fewer workers’ compensation files
• Initiates and investigates promptly
• Determines compensability of claims and administers benefits based upon state law
• Manages medical treatment and medical billing, authorizing as appropriate
• Communicates with claimants, providers, and vendors regarding claims issues
• Computes and sets reserves within Company guidelines
• Maintains diary system for case review
• Communicates appropriate information promptly to the client to resolve claims efficiently
• Adheres to all Company policies and procedures
• Conducts file reviews as scheduled by the client and management

Workers Compensation Claims Examiner II

• 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

Commercial Auto No Fault, PIP Claims Examiner III – Temp

Claims Examiner III

Commercial Auto, BI & GL Claims Examiner III

Workers Compensation Claims Examiner II

Worker Compensation Claims Examiner III