Claims Examiner III (Hybrid)

Job Details: Level: Experienced | Location: Albuquerque Office - Albuquerque, NM 87110 | Position Type: Full Time | Salary Range: $70,000.00 - $85,000.00 | Shift: Day | Category: Insurance. (Hybrid, temp-to-hire opportunity) Position Summary Under minimal supervision, manage all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. Duties and Responsibilities Effectively manage an average caseload of 130 workers’ compensation files, including very complex claims. Initiate and conduct investigations in a timely manner. Determine compensability of claims and administer benefits based upon state law and company guidelines. Develop and manage claims through well-developed action plans to bring the claim to a timely resolution. Manage medical treatment and billing, authorizing as appropriate. Calculate and pay benefits due; approve all claim payments. Refer cases to outside defense counsel and direct as appropriate. Manage claim recoveries of all types, including deductible and subrogation. Communicate with clients, claimants, providers and vendors regarding claim issues. Compute and set reserves within company guidelines. Settle or finalize all claims and obtain designated authority. Maintain diary system for case review and document file status. Communicate relevant information promptly to clients to resolve claims efficiently, including injury trends or safety concerns. Adhere to all company policies and procedures. Conduct file reviews independently. Perform other duties as assigned. Equipment Operated/Used Computer, 10-key, fax machine, copier, printer, and other office equipment. Qualifications Education: Bachelor’s degree in a related field (preferred) or five (5) or more 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. Proficiency in Word and Excel (preferred). Knowledge of self-insured claims handling (preferred). City, county, and/or district claims handling experience (preferred). Certifications and/or licenses as required by state regulation. Benefits Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan. Paid Holidays. Paid Time Off. Referral bonus. #J-18808-Ljbffr Tristar Insurance