Workers Compensation Claims Examiner I

Tristar Insurance•Waukesha, WI

6d•$19 - $24•Onsite

About The Position

Under close supervision, manages medical-only workers’ compensation claims from inception to conclusion within established authority and guidelines. The role involves considerable interaction with clients and claimants by phone, as well as with management, other Claims Examiners, and other TRISTAR staff in the office. Consistent, punctual attendance is inherently required. The position is full-time, day shift, based in Milwaukee–Waukesha, Wisconsin, with no travel. The listed pay range is $19.23–$24.03 per hour. The position requires a high school diploma or GED and at least one year of related experience, or an equivalent combination of education and experience. An active adjuster’s license in Indiana, Minnesota, or Michigan, or a license in a state with reciprocity, is required. A related bachelor’s degree and proficiency in Word and Excel are preferred. The job is classified as light work. The listed physical requirements include lifting up to 20 pounds occasionally and up to 10 pounds frequently. The checklist also indicates requirements involving near, mid-range, and far vision; occasional stooping, kneeling, reaching, standing, walking, pushing, pulling, lifting, fingering, and grasping; and frequent talking, hearing, and repetitive wrist, hand, or finger motions. The position uses a computer, fax machine, copier, printer, and other office equipment, and requires appropriate office attire.

Requirements

High school diploma or GED.
At least one year of related experience, or an equivalent combination of education and experience.
Active adjuster’s license in Indiana, Minnesota, or Michigan, or a license in a state with reciprocity.
Technical understanding 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 of the business environment.

Nice To Haves

Bachelor’s degree in a related field.
Proficiency in Microsoft Word and Excel.

Responsibilities

Manage an assigned medical-only workers’ compensation claims caseload effectively.
Initiate and conduct three-point contacts promptly according to client and TRISTAR requirements.
Determine claim compensability and administer benefits under state law and established company guidelines.
Manage medical treatment and billing, authorizing treatment or payments as appropriate.
Refer claims to an Indemnity Examiner when they meet indemnity conversion qualifications under TRISTAR best practices, including when the $10,000 limit is met.
Communicate with claimants, providers, and vendors regarding claims issues.
Compute and set reserves within company guidelines.
Maintain a diary system for case review and document files reflecting claim status and work performed.
Promptly communicate appropriate information to clients to resolve claims efficiently, including injury trends and other safety-related concerns.
Adhere to company policies and procedures.
Perform other duties as assigned.