Claim Processor - Temporary

Claims Examiner III (Hybrid)
Hybrid Fresno Office - Fresno, CA 93727
Salary Range $35.00 - $43.00 Hourly Level Experienced Position Type Temporary Job Shift Day Category Insurance
Claims Examiner III (Hybrid)
Please make sure to complete all the questions in the application and continue through to the end in order to sign and submit it. Please note that this position is a hybrid, temp-to-hire opportunity.
SIP is required for this position.
POSITION SUMMARY: Under general 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, 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 complex claims.
Initiates and conducts claims investigation in a timely manner.
Determines compensability of claims and administer 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. Monitors legal aspects.
Communicates with claimants, providers and vendors regarding claims issues.
Computes and set reserves within Company guidelines. Limits are less than those allowed for Claims Examiner III, but larger than those for Claims Examiner I.
Settles and/or finalize all claims and obtains authority as designated.
Maintains 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.
Adheres to all Company policies and procedures.
Participates in file reviews, as needed.
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

QUALIFICATIONS REQUIRED:

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 :

~ Certification and/or or license as required by State regulation.

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.