Workers Compensation Claims Examiner III _ Temp

TRISTAR RISK MANAGEMENT•Chino Hills, CA

1d•Onsite

About The Position

The Workers Compensation Claims Examiner III is an experienced, temporary position responsible for managing all aspects of indemnity claims from inception to conclusion, operating under minimal supervision and within established authority and guidelines. This role requires consistent in-office presence due to significant interaction with clients, claimants, management, and other TRISTAR staff. The examiner will handle a complex caseload of 150 to 180 workers’ compensation files, initiating investigations, determining compensability, and administering benefits in accordance with state law and company policies. Key duties include managing medical treatment and billing, referring and directing outside defense counsel, communicating with various stakeholders, computing and setting reserves with larger limits than lower-level examiners, and finalizing claims. The position also involves maintaining a case review diary, documenting files, promptly communicating client information, and adhering to all company policies and procedures, including conducting independent file reviews.

Requirements

High School Diploma or GED
Three (3) or more years related 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
Certifications and/or licenses as required by State regulation

Nice To Haves

Bachelor’s degree in related field
Proficient in Word and Excel

Responsibilities

Manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
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.