Claims Examiner III

Responsibilities 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 and monitors legal aspects. Communicates with claimants, providers, and vendors regarding claims issues. 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 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 Bachelor’s degree in a related field (preferred) or one (1) to five (5) years of related experience; or an equivalent combination of education and experience. Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the 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. #J-18808-Ljbffr