Workers' compensation Claims Examiner I / Medical Only

TRISTAR RISK MANAGEMENT•Waukesha, WI

2d•$19 - $24•Onsite

About The Position

Under close supervision, manages all aspects of medical only and 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; therefore, consistently being at work on time is inherently required of this position.

Requirements

High School Diploma or GED required
one (1) year or more related experience; or an equivalent combination of education and experience.
Technical understanding of statutory regulations and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff.
Ability to interact with persons at all levels in the business environment.
Ability to understand and follow one- or two-step instructions; routine, repetitive tasks.
Ability to carry out detailed but uninvolved written or verbal instructions; deal with a few concrete variables.
Ability to perform arithmetic calculations involving fractions, decimals, and percentages.
Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.
Near vision: clarity of vision at 20 inches or less
Stooping
Kneeling
Crouching
Reaching
Standing
Walking
Pushing
Pulling
Lifting
Fingering
Grasping
Talking
Hearing
Feeling
Repetitive Motion

Nice To Haves

Bachelor’s degree in a related field (preferred)
Proficient in Word and Excel (preferred)

Responsibilities

Effectively manages an assigned medical-only caseload of workers’ compensation claims.
Initiates and conducts 3-point contacts promptly according to Client and TRISTAR.
Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.
Manages medical treatment and medical billing, authorizing as appropriate.
Refers cases to Indemnity Examiner if claims meet indemnity conversion qualification per TRISTAR best practices.
Communicates with claimants, providers, and vendors regarding claims issues.
Computes and sets reserves within Company guidelines. Limits are $10,000, and the claim is referred to the Indemnity Examiner once met.
Maintains diary system for case review and document file to reflect the status of and work performed on the file.
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
Adheres to all Company policies and procedures.
Other duties as assigned.