Workers Compensation Claims Examiner I

Tristar Insurance•Signal Hill, CA

6d•$24 - $30•Hybrid

About The Position

Under close supervision manages all aspects of indemnity claims 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 in the office, in a timely manner, is inherently required of this position.

Requirements

High school diploma or GED required; Bachelor’s degree in related field (preferred); 2 -3 years 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 people at all levels in the business environment.
Ability to effectively manage claims with high level of supervision.
Proficient in Word and Excel (preferred).

Nice To Haves

Bachelor’s degree in related field
Proficient in Word and Excel

Responsibilities

Effectively manages a caseload of indemnity workers’ compensation files with supervison.
Initiates and conducts investigation in a timely manner based upon state law and TRISTAR Best Practices for claim handling with direction from supervisor.
Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines with direction from supervisor.
Manages medical treatment and medical billing, authorizing as appropriate based on TRISTAR claims Policies and Procedures
Staffs complex claims with supervisor to establish plan of action and obtain settlement authority to commence settlement negotiations with Applicant Attorney.
Communicates with claimants, providers and vendors regarding claims issues.
Maintains diary system for case review and document file to reflect the status and work being performed on the file.
Computes and set reserves based upon TRISTAR best practices with direction from supervisor.
Negotiates and/or finalize all claims based on settlement authority obtained from client with direction from supervisor.
Maintains diary system for case review and documents file to reflect the status 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 with direction from supervisor.
Adheres to all TRISTAR company policies and procedures.
Conducts ongoing file reviews with supervisor for development.
Other duties as assigned by supervisor.