Workers' Compensation Claims Examiner III

Job Details Level: Experienced Location: Denver - Lakewood, CO 80228 Position Type: Full Time Salary Range: $80,000.00 - $90,000.00/year Job Shift: Day Job Category: Insurance Position Summary Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, external business partners, and other TRISTAR staff. Duties and Responsibilities Effectively manage an average caseload of 130 workers’ compensation files, including very complex claims. Initiate and conduct an investigation in a timely manner. Determine compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines. Develop and manage claims through well-developed action plans; continue working the action plan to stay on task and bring the claim to an appropriate and timely resolution. Manage medical treatment and medical billing, authorizing as appropriate. Calculate and pay benefits due and approve all claim payments. Refer cases to outside defense counsel and direct and manage 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 and/or finalize all claims and obtain authority as designated. Maintain a diary system for case review and document the file to reflect the status and work being performed on the file. Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related 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. Special Equipment or Clothing Appropriate office attire. Qualifications Education/Experience • Bachelor’s degree in a related field (preferred); five (5) or more years of 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 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). 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 Services LLC