Workers Compensation Claims Examiner

Job Details: Level: Experienced. Job Location: Milwaukee - Waukesha, WI 53186. Position Type: Temporary. Education Level: High School Diploma or GED. Salary Range: $72,800.00 - $83,200.00. Travel Percentage: None. Job Shift: Day. Job Category: Admin - Clerical. This will be an in‑office position. The location will be the TRISTAR office that is closest to where the candidate lives. 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 on time is inherently required of this position. DUTIES AND RESPONSIBILITIES 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. Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* 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.* 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 Education/Experience: Bachelor’s degree in a related field (preferred); three (3) 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 conveying 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). Benefits Medical, Dental & Vision Insurance Life & Disability Insurance 401(k) plan Paid holidays Paid time off Referral bonus Mental and Physical Requirements [see separate attachment for a copy of the checklist of mental and physical requirements] #J-18808-Ljbffr