Workers Compensation Claims Examiner III _ Temp

Job Details Level: Experienced Location: Signal Hill Office – Signal Hill, CA 90755 Position Type: Temporary Education Level: High School Diploma or GED Salary Range: $93,600.00 – $104,000.00 Travel Percentage: None Shift: Day Job Category: Admin – Clerical Position Summary Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 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 in the office, in a timely manner, is inherently required of this position. Duties and Responsibilities Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims. Initiates and conducts 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; directs and manages as appropriate. Communicates with claimants, providers and vendors regarding claims issues. Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. Settles and/or finalizes all claims and obtains authority as designated. Maintains diary system for case review and documents 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. Adheres to all Company policies and procedures. Conducts file reviews independently. Other duties as assigned. Essential job function. Equipment Operated/Used Computer, 10-key, fax machine, copier, printer, and other office equipment. Special Equipment or Clothing Appropriate office attire. Qualifications Required Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills and Abilities: Technical knowledge of statutory regulations and medical terminology. 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. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: Certifications and/or licenses as required by State regulation. Benefits Medical, Dental & Vision Insurance Life & Disability Insurance 401(K) Plan Paid time off Paid holidays Mental and Physical Requirements See separate attachment for a copy of checklist of mental and physical requirements. Mental Effort Reasoning development: follows one‑ or two‑step instructions; routine, repetitive task. Multi‑step reasoning; logical or scientific thinking to solve problems; many abstract and concrete variables. Mathematical Development Basic arithmetic: addition, subtraction, multiplication, division of whole numbers. Advanced calculations: fractions, decimals, percentages; algebraic, geometric. Advanced statistical techniques such as calculus, factor analysis, probability determination. Language Development Understanding and following verbal or written instructions. Transcribing dictation; writing letters or routine correspondence. Ability to compose original correspondence; interpret technical manuals; produce analytical reports. Physical Effort Light work: up to 20 pounds occasionally/frequently. Medium work: up to 50 pounds occasionally, up to 20 pounds frequently. Heavy work: up to 100 pounds occasionally, up to 50 pounds frequently. Very heavy work: >100 pounds occasionally, >50 pounds constantly. Miscellaneous Physical Activities Stooping, kneeling, crouching, reaching, standing, walking, pushing, pulling, lifting, fingering, grasping, etc., with frequencies indicated as occasional or frequent. Working Conditions Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify): #J-18808-Ljbffr