Workers Compensation Claims Examiner II

TRISTAR RISK MANAGEMENT • Irving, TX

5d • $70,000 - $75,000 • Onsite

About The Position

Under general supervision, manages workers’ compensation indemnity claims of moderate to complex difficulty from inception through resolution within assigned authority limits and established company and client guidelines. Exercises independent judgment in routine and complex claims handling and seek supervisory guidance on unusual, high-exposure, or sensitive matters.

Requirements

• Bachelor’s degree in related field (preferred); and three (3) to five (5) 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 independently and effectively manage very complex claims.
• Certification and/or or license as required by State regulation.
• Logical or scientific thinking to solve problems; several abstract and concrete variables.
• Arithmetic calculations involving fractions, decimals, and percentages.
• Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
• 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. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Near vision: clarity of vision at 20 inches or less
• Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
• Grasping: Applying pressure to an object with the fingers and palm.
• Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
• Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.
• Repetitive Motion: Substantial movements (motions) of the wrists, hands, and/or fingers.

Nice To Haves

• Proficient in Word and Excel (preferred).

Responsibilities

• Manages a caseload of approximately 150–180 workers’ compensation claims of moderate to complex difficulty.
• Calculates and establishes reserves and authorizes payments and settlements within assigned authority limits, which are lower than those assigned to Claims Examiner III.
• Identifies and escalates claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding assigned authority.
• Refers claims to defense counsel as appropriate and monitors litigation activities, consulting with the supervisor on significant legal developments and settlement strategy.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED