Workers Compensation Claims Examiner III _ New York

Tristar Insurance•Philadelphia, PA

6d•$75,000 - $85,000•Hybrid

About The Position

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This is a full-time position that 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

Education/Experience: 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.
Must have a valid New York state adjuster license

Nice To Haves

Proficient in Word and Excel (preferred).

Responsibilities

Adjuster will work remotely from home
Effectively manages a caseload of 100 to 125 workers’ compensation files, including very complex claims.
Jurisdiction is NY.
Initiates and conducts investigations in a timely manner.
Determines compensability of claims and administers 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 sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
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.
Involves TRISTAR loss control staff when appropriate.
Adheres to all Company policies and procedures.
Conduct file reviews independently.
Other duties as assigned.
Essential job function.