Claims Examiner I (Medical Only adjuster experience)

Tristar Insurance • San Antonio, TX

2d • $40,000 - $50,000 • 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.

Requirements

• Minimum of 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 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).
• Computer, telephone, 10-key, fax machine, printers and other basic office equipment.

Nice To Haves

• Proficient in Word and Excel

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.
• 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.
• 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.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed