Claims Examiner III - WC

Job Location(s) US-Houston
Job ID
2017-1448
# of Openings
2
Category
Worker's Compensation
Job Type
Temporary Full-Time

Overview

 

 

TRISTAR Insurance Group began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR Insurance Group.

Since our merger with Risk Enterprise Management in 2012, we became the largest privately held third party claims administrator. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services.

We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically.

At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity.

Responsibilities

Role and Responsibilities

  • Handle loss time WC claims in TX.  
  • Handle claims as per BP , SOC 1 and client CHI’s.
  • The ability to prepare a formal captioned report on claims meeting client requirements
  • Well organized
  • Ability to effectively communicate in a professional manner
  • Provide great customer service .
  • Assist employers and their employee’s understand the WC process
  • Investigate, evaluate, determine compensability, pay benefits timely as required and comply with all statutory requirements.
  • A good sense of urgency
  • Ability to get along well with others.

Qualifications

QUALIFICATIONS REQUIRED:

 

Education/Experience:  Bachelor’s degree in related field (preferred); five (5) or more years related experience handling Texas workers compensation claims; or equivalent combination of education and experience.  High School Diploma or GED required.

 

Knowledge, Skills and Abilities:

  • 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).

 

Other Qualifications

  • Workers Compensation Adjuster's License for state of Texas

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