Workers Compensation Claims Examiner I
About The Position
Under close supervision, the Workers Compensation Claims Examiner I manages medical-only workers’ compensation claims from inception through 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 TRISTAR staff in the office. Consistent, punctual attendance is an inherent requirement of the position. The assigned medical-only caseload is managed according to state law, client requirements, and company guidelines. The role also includes maintaining claim records and communicating relevant claim information and safety concerns to clients.
Requirements
- High school diploma or GED.
- One or more years of related experience, or an equivalent combination of education and experience.
- An active Indiana, Minnesota, or Michigan adjuster’s license, 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 in a business environment.
- Proficiency in Microsoft Word and Excel is preferred.
Nice To Haves
- Bachelor’s degree in a related field.
- Proficiency in Microsoft Word and Excel.
Responsibilities
- Effectively manage an assigned medical-only workers’ compensation claims caseload.
- Initiate and conduct three-point contacts promptly according to client and TRISTAR requirements.
- Determine claim compensability and administer benefits based on state law and established company guidelines.
- Manage medical treatment and medical billing, authorizing treatment or billing as appropriate.
- Refer cases to an Indemnity Examiner when they meet indemnity-conversion qualifications or the stated claim limit is met.
- Communicate with claimants, providers, and vendors regarding claim issues.
- Compute and set reserves within company guidelines; refer the claim to an Indemnity Examiner once the $10,000 limit is met.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
