Claims Examiner I

Tristar Insurance•Corpus Christi, TX

2d•$25 - $25•Onsite

About The Position

Under close supervision, the Claims Examiner I manages medical-only workers’ compensation claims from inception through conclusion, within established authority and guidelines. The position involves substantial interaction by phone with clients and claimants, as well as regular communication with management, other Claims Examiners, and TRISTAR staff. Consistent, timely attendance in the office is inherently required. The role manages a caseload of 150 to 180 files, investigates claims, determines compensability, administers benefits, and coordinates medical treatment and billing. It also maintains claim documentation and review diaries, sets reserves within company guidelines, and communicates relevant claim information and safety concerns to clients. The position reports to an unspecified supervisor and performs other duties as assigned. The job is full-time, day shift, and based in the Corpus Christi office. The listed pay is $25.00 per hour. The stated physical requirements classify the work as light work and identify near, mid-range, and far vision requirements, along with specified physical activities and communication demands.

Requirements

Minimum of one year of related experience, or an 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 people at all levels in a business environment.
Ability to perform light work, including exerting up to 20 pounds occasionally and up to 10 pounds frequently.
Near, mid-range, and far vision sufficient to perform the job.
Physical activities listed include stooping, kneeling, reaching, standing, walking, pushing, pulling, lifting, fingering, grasping, talking, hearing, and repetitive wrist, hand, and finger motions.

Nice To Haves

Proficiency in Microsoft Word and Excel is preferred.

Responsibilities

Manage a caseload of 150 to 180 workers’ compensation files.
Initiate and conduct claims investigations in a timely manner.
Determine claim compensability and administer benefits based on state law and company guidelines.
Manage medical treatment and medical billing, authorizing as appropriate.
Communicate with claimants, providers, and vendors regarding claims issues.
Compute and set reserves within company guidelines.
Maintain a diary system for case review and keep document files current regarding claim status and work performed.
Promptly communicate appropriate information to clients to resolve claims efficiently, including injury trends or safety-related concerns.
Involve TRISTAR loss control staff when appropriate.
Adhere to company policies and procedures.
Participate in file reviews as needed.
Perform other duties as assigned.