• Claims Examiner III- Workers Compensation

    Job Location(s) US-Remote | US-PA-Suite 720 | US-NJ-Cranbury
    Job ID
    # of Openings
    Worker's Compensation
    Job Type
    Regular Full-Time
  • Overview

    Workers' compensation claims examiner to handle lost time claims in New York.   Must be licensed in New York.




    • Effectively manages a caseload of 125 to 150 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. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.*
    • 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.*
    • Involves TRISTAR loss control staff when appropriate.*
    • Adheres to all Company policies and procedures.*
    • Conducts file reviews independently.*
    • Other duties as assigned.

    * Essential job function.





    Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.


    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:

    • New York license.


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