Workers Compensation Claims Examiner III

Role Description

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.

Qualifications

• Bachelor’s degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience.
• Must have an adjuster's license in Minnesota, Michigan & Indiana.
• 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).

Requirements

• Must have an adjuster's license for Michigan, Minnesota & Indiana.

Benefits

• Medical, Dental & Vision Insurance
• Life & disability Insurance
• 401(k) plan
• Paid holiday
• Paid time off
• Referral bonus