Claims Examiner I (Medical Only adjuster experience)

Position Summary Under close supervision, manages all aspects of medical-only claims handling from inception to conclusion within established authority and guidelines. Job Details Level: Experienced Location: San Antonio, TX Position Type: Full Time Salary Range: $40,000.00 - $50,000.00 per year Shift: Day Category: Insurance Duties and Responsibilities Effectively manage a caseload of 150 to 180 workers’ compensation files. Initiate and conduct claims investigations in a timely manner. Determine compensability of claims and administer benefits based on state law and company guidelines. Manage medical treatment and medical billing, authorizing as appropriate. Communicate with claimants, providers, and vendors regarding claim issues. Compute and set reserves within company guidelines. Maintain a diary system for case review and document file status. Communicate appropriate information promptly to the client to resolve claims efficiently, including injury trends and safety concerns. Involve TRISTAR loss control staff when appropriate. Adhere to all company policies and procedures. Participate in file reviews, as needed. Perform other duties as assigned. Qualifications Minimum of one (1) year of related experience or equivalent combination of education and experience. Technical knowledge of statutory regulations and medical terminology. Strong analytical skills. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff. Ability to interact with persons at all levels in the business environment. Proficiency in Microsoft Word and Microsoft Excel (preferred). Benefits Medical, Dental, and Vision Insurance Life and Disability Insurance 401(k) Plan Paid Holidays Paid Time Off Referral Bonus Mental and Physical Requirements Physical activity required is light, including occasional lifting up to 20 pounds, frequent light carrying, and occasional manual tasks such as typing, dialing, and filing. Visual requirements include near, mid-range, and far vision; color vision; and field of vision at required distances. Repetitive motions of hands, wrists, and fingers are expected; the role requires adequate manual dexterity and endurance. Standard office environment with occasional movement and use of basic office equipment such as computers, telephones, fax, printers, and 10-key devices. #J-18808-Ljbffr Tristar Insurance Services LLC