Claims Examiner III (Hybrid)
TRISTAR Insurance Group
- # Claims Examiner III (Hybrid)**This will be a permanent Floating Examiner position to cover open desks due to Vacations, Leaves of Absence, new business onboarding, increased pending inventories, Auditing, etc.****SIP Must**At the Direction of the Claims Supervisor and/or Manager, under minimal supervision, manages all aspects of Workers’ Compensation claims (complex, litigated, non-disabling) claims from inception to conclusion within established authority and guidelines. The position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, Nurse and Vocational Case Managers, and other TRISTAR staff. **DUTIES AND RESPONSIBILITIES:*** Effectively manages a Temporary caseload of Workers’ Compensation 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. \** Communicate with claimants, attorneys, providers, and vendors regarding claims issues. \** Work 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.\** Identify and review claims for the Apportionment assignment. \** Identify and investigate subrogation potential and pursue recovery.\** Identify claim standard criteria for excess reporting and reimbursement.\** Assist with State Audit and reporting responses.\** Mentors less experienced Examiners* Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.* Adheres to all TRISTAR company policies and procedures. \***Essential job function.****EQUIPMENT OPERATED/USED:** Computer, 10-key, fax machine, copier, printer, and other office equipment.**SPECIAL EQUIPMENT OR CLOTHING:** Appropriate office attireEducation/Experience: Minimumfive (5) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities:Other Qualifications: * Medical, Dental, Vision Insurance.* Life and 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] Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; and guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases; prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: the ability to identify and distinguish colors Field of vision: the ability to observe an area up or down or to the right or left while eyes are fixed on a given point X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
- J-18808-Ljbffr TRISTAR Insurance Group
Vacancy posted 3 days ago
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