Workers Compensation Claims Examiner III _ Temp /Perm

Tristar Insurance•San Diego, CA

3d•$93,600 - $104,000•Onsite

About The Position

Under minimal supervision, this position manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This role requires considerable interaction with clients and claimants over the phone, as well as with management, other Claims Examiners, and TRISTAR staff in the office. Therefore, consistent and timely attendance in the office is a requirement of this position.

Requirements

Bachelor’s degree in related field (preferred); three (3) or more 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 persons at all levels in the business environment.
Ability to independently and effectively manage very complex claims.
Proficient in Word and Excel (preferred).
Certifications and/or licenses as required by State regulation.

Nice To Haves

Proficient in Word and Excel (preferred).

Responsibilities

Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims.
Initiates and conducts investigation in a timely manner.
Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
Manages medical treatment and medical billing, authorizing as appropriate.
Refers cases to outside defense counsel.
Directs and manages as appropriate.
Communicates with claimants, providers and vendors regarding claims issues.
Computes and set reserves within Company guidelines.
Settles and/or finalize all claims and obtains authority as designated.
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.
Adheres to all Company policies and procedures.
Conducts file reviews independently.
Other duties as assigned.