Medical Only Claims Examiner - Temporary

Job Location(s) US-CA-Fresno
Job ID
2017-1455
# of Openings
1
Category
Worker's Compensation
Job Type
Temporary Full-Time

Overview

POSITION SUMMARY:  Under close supervision manages all aspects of medical only claims handling from inception to conclusion within established authority and guidelines. 

 

This position 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.

Responsibilities

 

DUTIES AND RESPONSIBILITIES:

 

  • Effectively manages an assigned caseload of workers compensation claim.*
  • Initiates and conducts claims 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.*
  • Communicates with claimants, providers and vendors regarding claims issues.*
  • Computes and set reserves within Company guidelines.  Limits are less than those allowed for Claims Examiner II and Claims Examiner III.*
  • Maintains diary system for case review and document file to reflect the status of 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.*
  • Participates in file reviews, as needed.
  • Other duties as assigned.

 

*Essential job function.

Qualifications

QUALIFICATIONS REQUIRED:

 

Education/Experience:  (1) year related experience; or equivalent combination of education and experience. 

 

Knowledge, Skills and Abilities:

  • Technical knowledge of statutory regulations and medical terminology.
  • 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.
  • Proficient in Word and Excel (preferred).

 

Other Qualifications

  • Certification and/or or license as required by State regulation.

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