Claims Examiner I (Medical Only)

TRISTAR RISK MANAGEMENT•Phoenix, AZ

1d•Hybrid

About The Position

Under close supervision, manages all aspects of medical-only claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients and 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. (Hybrid in/out of office, depending on requirements for the office)

Requirements

Minimum of two (2) years related experience; or 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.
Computer, fax machine, copier, printer, and other office equipment.

Nice To Haves

Proficient in Word and Excel (preferred).
Arizona Adjuster’s License (preferred).

Responsibilities

Effectively manages an assigned caseload of workers' compensation claims.
Initiates and conducts claims 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.
Communicates with claimants, providers, and vendors regarding claims issues.
Computes and sets reserves within Company guidelines.
Maintains a diary system for case review and document file to reflect the status of and work being performed on the file, including a plan of action.
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
Adheres to all TRISTAR company policies and procedures.
Participates in file reviews, as needed.
Other duties as assigned, including claims management of other jurisdictional workers’ comp claims.