Workers Compensation Claims Examiner III

Tristar Insurance • Honolulu, HI

65d • $70,000 - $85,000 • Onsite

About The Position

At the Direction of the Claims Supervisor, manages all aspects of indemnity and future medical claims from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants, Medical providers, Vendors, and other TRISTAR staff in the office.

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
• Bachelor’s degree in related field

Responsibilities

• Effectively manages a caseload of 130 to 150 workers’ compensation files, including complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state laws/Rules 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/Client guidelines.
• Settles and/or finalizes 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
• Adheres to agreed client handling instructions
• Other duties as assigned.
• Essential job function

Benefits

• Medical, Dental, Vision, Disability and Life Insurance
• 401(k) plan
• Paid time off
• Paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees