Claims Examiner I- Workers Compensation (Hybrid)

Tristar Insurance • San Antonio, TX

82d • $21 - $24

About The Position

The Claims Examiner I for Workers Compensation is responsible for managing all aspects of Medical Only 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. Consistent attendance at the office or home office location is required in a timely manner.

Requirements

• High School Diploma or GED required; Bachelor's degree in related field preferred.
• One (1) year 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.
• Proficient in Word and Excel (preferred).
• Certification and/or license as required by State regulation (Texas State WC License).

Responsibilities

• Effectively manages a caseload of 150 to 180 workers’ compensation files.
• 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, with requests for surgical treatment to be referred to supervisor prior to authorizing.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Maintains diary system for case review and document file to reflect the status of 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 to include assisting as a claims assistant.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees