Claims Examiner III
Tristar Insurance•Corpus Christi, TX
•$60,000 - $75,000
About The Position
Under minimal supervision, the Claims Examiner III manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. The role requires considerable interaction with clients, claimants by phone, management, other Claims Examiners, and other TRISTAR staff. The position manages a caseload of approximately 150 workers’ compensation files, including very complex claims, and has larger limits than Claims Examiner I and II. The job is based in Corpus Christi, Texas, and is listed as full time on the day shift.
Requirements
- Three or more years 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 independently and effectively manage very complex claims.
- Texas Workers' Compensation License.
Nice To Haves
- Bachelor’s degree in a related field (preferred).
- Proficiency in Microsoft Word and Excel (preferred).
Responsibilities
- Manage a caseload of 150 workers’ compensation files, including very complex claims.
- Initiate and conduct investigations in a timely manner.
- Determine claim compensability and administer benefits in accordance with state law and company guidelines.
- Manage medical treatment and medical billing, authorizing as appropriate.
- Refer cases to outside defense counsel and direct and manage matters as appropriate.
- Communicate with claimants, providers, and vendors regarding claims issues.
- Compute and set reserves within company guidelines.
- Settle and/or finalize claims and obtain authority as designated.
- Maintain a diary system for case review and document files to reflect claim status and work performed.
- Promptly communicate appropriate information to clients to resolve claims efficiently, including injury trends and other safety-related concerns.
- Involve TRISTAR loss control staff when appropriate.
- Adhere to company policies and procedures.
- Conduct file reviews independently.
- Perform other duties as assigned.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- 401(k) plan
- Paid holidays
- Paid time off
- Referral bonus
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What This Job Offers
Job Type
Full-time
Career Level
Senior
